University of the Philippines

The Health Sciences Center

COLLEGE OF NURSING
Sotejo Hall, Pedro Gil Street, Manila
Drug Study
DRUG ORDER
(Generic
name,
Dosage,
Route,
Frequency,
etc.)
PHARMACOLOGI
C ACTION OF
DRUG
INDICATIONS AND
CONTRAINDICATIONS
ADVERSE EFFECTS OF
THE DRUG
DESIRED
ACTION ON
THE CLIENT
NURSING
RESPONSIBILITIES
/PRECAUTIONS
Amphotericin
B 0.15 cc +
1.35 cc D5W
OD
Increased cell
membrane
permeability in
susceptible
organisms by
binding sterols in
fungal membrane;
decreases
potassium, sodiumand nutrients in
the cell
Indications:
· Treatment of
severe, possiblyfatal fungal
infections
Contraindications:
· Hypersensitivity
· Severe bone
marrow depression
CNS: headache, fever,
chills, peripheral nerve
pain, paresthesias,
peripheral neuropathy,
seizures, dizziness
EENT: tinnitus, deafness,
diplopia, blurred visionGI: nausea, vomiting,
anorexia, diarrhea,
cramps, hemorrhagic
gastroenteritis, acute liverfailure
GU: hypokalemia,
axotemia, hyposthenuria,
renal tubular acidosis,
nephrocalcinosis,
permanent renal
impairment, anuria,
oliguriaBlood: normochromic and
normocytic anemia,
thrombocytopenia,
agranulocytosis,
leucopenia, eosinophilia,
hypokalemia,
hyponatremia,
hypomagnesemiaIntegumentary: burning,
irritation, pain, necrosis at
inj site with extravasation,
flushing, dermatitis, skin
Treat fungal
infection
· Monitor VS q1530 min during
first inf; note
changes in
pulse, BP.
· Monitor blood
studies
· Monitor weight
weekly; if weightincreases 2lb/wk,
edema is
present; renal
damage should
be considered.
· Monitor for renal
toxicity;
increasing BUN
and serum
creatinine
· Monitor for
hepatotoxicity;
increasing AST,
ALT, alkaline
phophatase
· Monitor for
allergic reaction
· Monitor for
hypokalemia
rash
MS: athralgia, myalgia,
generalized pain,
weakness, weight loss
Precautions:
· Pregnancy, renal
disease,
lactation
Meropenem 30
mg IV q12h
Interferes with cell
wall replication of
susceptible
organisms;
osmotically
unstable cell wall
swells and bursts
from osmotic
pressure
Indications:
· For serious
infections caused
by gram-positive
or gram-negative
organisms
Contraindications:
· Hypersensitivity to
meropenem or
imipenem
CNS: fever, somnolence,
seizures, dizziness,
weakness, headache,
myocloniaCV: hypotension,
palpitationsGI: diarrhea, nausea,
vomiting,
pseudomembraneous
colitis, hepatitis, glossitisBlood: eosinophilia,
neutropenia, decreased
Hgb, HctIntegumentary: rash,
urticaria, pruritus, pain at
inj site, phlebitis,
erythema at inj siteRESP: chest discomfort,
dyspnea, hyperventilation
Treat
bacterial
infection
· Assess patient
for previous
sensitivity
reaction to
carbapenems
· Assess patient
for signs and
symptoms of
infection,
including
characteristics of
wounds, sputum,
urine, stool
· Complete C/S
tests before
beginning drugtherapy
· Assess for
allergic
reactions,
anaphylaxis
· Identify urine
output
· Monitor blood
studies
· Monitor
electrolytes
· Assess bowel
pattern daily
· Monitor for
bleeding
Precautions:
· Pregnancy,
lactation, renal
disease, elderly
Furosemide
0.65 mg IV OD
Acts on the
ascending loop of
Henle in the
kidney; inhibiting
reabsorption of
electrolytes
sodium and
chloride, causingexcretion of
sodium, calcium,
magnesium,
chloride, water and
some potassium
Indications:
· Edema in CHF,
nephritic
syndrome, ascites
Contraindications:
· Hypersensitivity to
sulfonamides
· Anuria,
hypovolemia,
infants, lactation,
electrolyte
depletion
CNS: headache, fatigue,
weakness, vertigo,
paresthesiasCV: orthstatic
hypotension, chest pain,
ECG changes, circulatory
collapseEENT: loss of hearing, earpain, tinnitus, blurred
vision
ELECTROLYTES:
hypokalemia,
hypochloremic alkalosis,
hypoagnesemia,
hyperuricemiaENDO: hyperglycemia
GI: nausea, diarrhea, dry
mouth, vomiting,
anorexia, cramps,
pancreatitisGU: polyuria, reanl failure,
glycosuriaHEMA:
thrombocytopenia,
agranulocytosis,
leucopenia, anemiaINTEG: rash, pruritus,
purpura, sweating,
photosensitivity, urticariaMS: cramps, stiffness
Increase
patient s
urine output
· Assess patient
for tinnitus,
hearing loss, ear
pain
· Monitor for renal,
cardiac,
neiurologic, GI,
pulmonary
manifestation of
hypokalemia:
acidic urine,
decreased urine
osmolality,
nocturia,
polyuria and
polydipsia
· Monitor for CNS,
GI,
cardiovascular,
integumentary,
neurologic
manifestations
of hypocalcemia:
personality
changes,
anxiety,
disturbances
· Monitor for
manifestations
of hyponatremia
· Monitor
electrolytes
Precautions:
· Pregnancy, DM,
dehydration,
severe renal
disease,
cirrhosis, ascites
Ciprofloxacin 7
mg IV q12h
Bactericidal;
interferes with
DNA replication insusceptible
bacteria
preventing cell
Indications:
· For the treatment
of infections
caused by
susceptible gram-
negative bacteria,
CNS: Headache,
dizziness, insomnia,
fatigue, somnolence,
depression, blurred
vision
CV: Arrhythmias,
Treat
bacterial
infections
· Assess patient
for signs and
symptoms of
infection
· Obtain C/S
before beginning
reproduction. including E. coli, P.
mirabilis, K.
pneumoniae,
Enterobacter
cloacae, P.
vulgaris, P.
rettgeri, M.
morganii, P.
aeruginosa,
Citrobacter
freundii, S.
aureus, S.
epidermidis, group
D streptococci
Contraindications:
· Allergy to
ciprofloxacin,
norfloxacin or
other
fluoroquinolones,
pregnancy,
lactation.
hypotension, anginaEENT: Dry eye, eye pain,
keratopathy
GI: Nausea, vomiting, dry
mouth, diarrhea,
abdominal painHematologic: Elevated
BUN, AST, ALT, serum
creatinine and alkaline
phosphatase;
decreased WBC,
neutrophil count, HctOther: Fever, rash
drug therapy
· Assess for
anaphylaxis
· Identify urine
output
· Monitor blood
studies
· Monitor
electrolytes
· Assess bowel
pattern daily
· Monitor for
bleeding
Precautions:
· Pregnancy,
lactation,
children, renal
disease,
epilepsy
Pentoxifylline
1.3 mg + 4.7
cc D5W OD x
6o VSP x 6
days
Decreases blood
viscosity,
stimulates
prostacyclin
production,
increasing blood
flow by increasing
flexibility of RBCs,
reduces platelet
aggregation,
decreases
fibrinogenconcentration
Indications:
· Intermittent
claudication
related to chronic
occlusive vascular
disease
· Sickle cell anemia
Contraindications:
· Hypersensitivity
· Retinal, cerebral
hemorrhage
CNS: headache, anxiety,
tremors, confusion,
dizziness
CV: Angina, dysrhythmias,
palpiptations,
hypotension, chest
pain, dyspneaEENT: blurred vision,
earache, increased
salivation, sore throat,
conjunctivitis
GI: dyspepsia, nausea,
vomiting, anorexia,
belching, constipation,
dry mouth, thristINTEG: rash, pruritus,
urticaria, brittle
fingernailsOther: epistaxis, flulike
symptoms, nasal
congestion, malaise,
weight changes
Decrease
blood
viscosity
· Monitor BP and
respirations
· Assess for
intermittent
claudication
Precautions:
· Pregnancy,
angina pectoris,
cardiac disease,
impaired renal
function,
children, hepatic
disease
Piperacillintazobactam 70
mg IV q8h x
30 mins
Interferes with cell
wall replication of
susceptible
organisms;
osmotically
unstable cell wall
swells and bursts
from osmotic
pressure
Indications:
· Respiratory tract,
skin, bone and
joint infections
· Infections from
penicillinase-
producing
staphylococci
Contraindications:
· Hypersensitivity,
neonates
CNS: headache, insomnia,
dizziness, fever,
lethargy,
hallucinations, anxiety,
depression
GI: nausea, vomiting,
diarrhea, abdominal
pain, constipation,
pseudomembranous
colitis
GU: oliguria, proteinuria,
hematuria,
glomerulonephritisHEMA: anemia, increased
bleeding time, bone
barrow depressionINTEG: rash, pruritus
META: hypokalemia,
hypernatremiaSYST: anaphylaxis, serumsickness
Bactericidal
effects for
Methicillin-
resistant
Staphylococ
cus aureus
· Assess patient
for previoussensitivity
reaction to
penicillins
· Assess patient
for signs and
symptoms of
infection
· Obtain C&S
before beginning
drug therapy
· Assess for
allergic reactions
· Identify urine
output
· Monitor blood
studies
· Monitor
electrolytes
· Assess bowel
pattern daily
· Monitor for
bleeding
· Assess for
overgrowth ofinfection
Precautions:
· Pregnancy,
lactation,
seizures,
hypersensitivity
to
cephalosporins,
renal
insufficiency in
children
Midazolam
0.15 mg IV qh
Acts mainly at the
limbic system andreticular formation;
potentiates the
effects of GABA, an
inhibitory
Indications:
· IV or IM: Sedation,
anxiolysis, and
amnesia prior todiagnostic,
therapeutic, or
CNS: Transient, mild
drowsiness (initially);
sedation, depression,
lethargy, apathy,
fatigue, lightheadedness,
Sedation · monitor BP,
pulse, respiration
· monitor inj site
for redness,
pain, swelling
· assess
neurotransmitter;
anxiolytic and
amnesia effects
occur at doses
below those
needed to cause
sedation, ataxia;
has little effect on
cortical function.
endoscopic
procedures or
surgery

Induction of
general anesthesia
Continuous
sedation of
intubated and
mechanically
ventilated patients
as a component of
anesthesia or
during treatment
in the critical care
setting
Unlabeled uses:
Treatment of
epileptic seizure or
refractory status
epilepticus
Contraindications:

hypersensitivity to
benzodiazepines;
psychoses, acute
narrow-angleglaucoma, shock,
coma, acute
alcoholic
intoxication;
pregnancy (cleft
lip or palate,
inguinal hernia,
cardiac defects,
microcephaly,
pyloric stenosishave been
reported whenused in first
trimester;
neonatal
withdrawal
syndrome
reported in
infants); neonates.
disorientation,
restlessness,
confusion, crying,
delirium, headache,
slurred speech,
dysarthria, stupor,
rigidity, tremor,
dystonia, vertigo,
euphoria,
nervousness, difficultyin concentration, vivid
dreams, psychomotor
retardation,
extrapyramidal
symptoms; mild
paradoxical excitatory
reactions (during first
2 wk of treatment),
visual and auditory
disturbances, diplopia,
nystagmus, depressed
hearing, nasalcongestion
CV: Bradycardia,
tachycardia, CV
collapse, hypertension,
hypotension,
palpitations, edema
Dermatologic: Urticaria,
pruritus, skin rash,
dermatitis
GI: Constipation, diarrhea,
dry mouth, salivation,
nausea, anorexia,
vomiting, difficulty in
swallowing, gastric
disorders, elevations
of blood enzymes:
LDH, alkaline
phosphatase, AST, ALT,
hepatic dysfunction,
jaundice
GU: Incontinence, urinary
retention, changes inlibido, menstrual
irregularities
anterograde
amnesia

assess for
apnea,
respiratory
depression
Precautions:

COPD, CHF,
chronc renal
failure, chills,
debilitated,
neonates
Hematologic: Decreased
Hct, blood dyscrasiasOther: Phlebitis and
thrombosis at IV
injection sites,
hiccups, fever,
diaphoresis,
paresthesias, musculardisturbances,
gynecomastia; pain,
burning, and redness
after IM injection
Vecuronium
0.15 mg IV qh
(defer MAP
<26)
Inhibits
transmission of
nerve impulses by
binding with
cholinergicreceptor sites,
antagonizingaction of
acetylcholine; no
analgesic response
Indications:
· Facilitation of
endotracheal
intubation,
skeletal muscle
relaxation during
mechanical
ventilation
Contraindications:
· hypersensitivity
CNS: skeletal muscle
weakness
INTEG: urticaria
RESP: prolonged apnea,
possible respiratoryparalysis, bronchospasm,
flushing, wheezingSYST: anaphylaxis
Skeletal
muscle
paralysis
· monitor for
electrolyte
imbalances
· monitor patient s
VS
· monitor patient s
recovery
· monitor allergic
reactions
Precautions:
· cardiac disease,
pregnancy,
electrolyte
imbalances,
dehydration,
neuromuscular
disease
Dexamethaso
ne 0.16 mg IV
q6h x 6 doses
Enters target cells
and binds to
specific receptors,
initiating many
complex reactionsthat are
responsible for itsanti-inflammatory
and
immunosuppressiv
e effects.
Indications:
· Hypercalcemia
associated with
cancer
· Short-term
management of
various
inflammatory and
allergic disorders,
such as
rheumatoid
arthritis, collagen
diseases (SLE),
dermatologic
CNS: Seizures, vertigo,
headaches, pseudotumor
cerebri, euphoria,
insomnia, mood swings,
depression, psychosis,
intracerebral hemorrhage,
reversible cerebral
atrophy in infants,
cataracts, increased IOP,
glaucomaCV: Hypertension, CHF,
necrotizing angiitisEndocrine: Growth
retardation, decreased
Decrease
inflammatio
n
· monitor
potassium,
blood, urine
glucose while on
long term
therapy
· monitor weight
daily
· monitor VS q4h
· monitor I&O
ratio; be alert for
decreasing
urinary output
diseases
(pemphigus),
status
asthmaticus, and
autoimmune
disorders

Hematologic
disorders:
Thrombocytopenic
purpura,
erythroblastopenia

Trichinosis with
neurologic or
myocardial
involvement
Cerebral edema
associated with
brain tumor,
craniotomy, or
head injury
Testing
adrenocortical
hyperfunction
Unlabeled uses:
Antiemetic for
cisplatin-inducedvomiting,
diagnosis of
depression
Respiratory
inhalant: Control
of bronchial
asthma requiring
corticosteroids in
conjunction with
other therapy
Intranasal: Relief
of symptoms of
seasonal or
perennial rhinitis
that responds
poorly to other
treatments
Ophthalmic
carbohydrate tolerance,
diabetes mellitus,
cushingoid state,
secondary adrenocorticaland pituitaryunresponsiveness
GI: Peptic or esophageal
ulcer, pancreatitis,
abdominal distention
GU: Amenorrhea,
irregular mensesHematologic: Fluid and
electrolyte disturbances,
negative nitrogen balance,
increased blood sugar,
glycosuria, increased
serum cholesterol,
decreased serum T3 and T4
levels
Hypersensitivity:
Anaphylactoid or
hypersensitivity reactions
Musculoskeletal: Muscle
weakness, steroid
myopathy, loss of muscle
mass, osteoporosis,
spontaneous fractures
Other: Impaired woundhealing; petechiae;
ecchymoses; increasedsweating; thin and fragileskin; acne;
immunosuppression andmasking of signs ofinfection; activation of
latent infections, including
TB, fungal, and viral eye
infections; pneumonia;
abscess; septic infection;
GI and GU infections

assess infection
assess mental
status
Precautions:

pregnancy,
lactation, DM,
glaucoma,osteoporosis, seizure
disorders,
ulcerative colitis,
CHF, myasthenia
gravis, renal
disease, peptic
ulcer.
preparations:
Inflammation of
the lid,
conjunctiva,
cornea, and globe
Contraindications:
· infections,
especially
tuberculosis,
fungal infections,
amebiasis,
vaccinia and
varicella, and
antibiotic-resistant
infections, allergy
to any component
of the preparation
used.
Erythromycin
125g/5ml 0.15
ml po q6h
Bacteriostatic or
bactericidal in
susceptiblebacteria; binds to
cell membrane,
causing change in
protein function,
leading to cell
death.
Indications:
· Acute infections
caused by
sensitive strains of
Streptococcuspneumoniae,
Mycoplasmapneumoniae,
Listeria
monocytogenes,
Legionellapneumophila
· URIs, lower
respiratory tract
infections, skin
and soft-tissue
infections caused
by group A beta-
hemolytic
streptococci when
oral treatment is
preferred to
injectable
benzathine
penicillin
· In conjunction with
CNS: Reversible hearing
loss, confusion,
uncontrollable emotions,
abnormal thinkingCV: Ventricular
arrhythmias (with IV)
GI: Abdominal cramping,
anorexia, diarrhea,
vomiting,
pseudomembranouscolitis, hepatotoxicityHypersensitivity:
Allergic reactions ranging
from rash to anaphylaxis
Other: Superinfections
· Assess patient
for signs and
symptoms of
infection
· Obtain C&S
results before
beginning
therapy
· Assess for
allergic reactions
· Identify urine
output
· Monitor blood
studies
· Monitor
electrolytes
· Assess bowel
pattern daily
· Assess for
overgrowth of
infection
Precautions:
· Pregnancy,
lactation
sulfonamides in
URIs caused by
Haemophilusinfluenzae
· As an adjunct to
antitoxin in
infections caused
by
Corynebacteriumdiphtheriae and
Corynebacteriumminutissimum
· Prophylaxis
against alpha-
hemolytic
streptococcal
endocarditis
before dental or
other procedures
in patients allergicto penicillin who
have valvular
heart disease
Contraindications:
· Allergy to
erythromycin
Spironolactone
0.75 mg/tab ½
tab OD
Competitively
blocks the effects
of aldosterone in
the renal tubule,
causing loss of
sodium and water
and retention of
potassium.
Indications:
· Diagnosis and
maintenance of
primary
hyperaldosteronis
m
· Adjunctive therapy
in edema
associated with
CHF, nephrotic
syndrome, hepatic
cirrhosis when
other therapies
are inadequate or
inappropriate
· Treatment of
hypokalemia or
prevention of
CNS: Dizziness,
headache, drowsiness,
fatigue, ataxia, confusionDermatologic: Rash,
urticaria
GI: Cramping, diarrhea,
dry mouth, thirst,
vomiting.
GU: Impotence, irregularmenses, amenorrhea,
postmenopausal bleedingHematologic:
Hyperkalemia,
hyponatremia,
agranulocytosisOther: Carcinogenic in
animals, deepening of thevoice, hirsutism,
Increased
urine output
· monitor for
manifestations
of hyperkalemia
· monitor for
manifestations
of hyponatermia
· Assess fluid
volume status:
I&O ratios;
crackles in lung,
urine quality
· Monitor
electrolytes
Precautions:
· Dehydration,
hepatic disease,
hypokalemia in
patients who
would be at high
risk if hypokalemia
occurred:
Digitalized
patients, patients
with cardiac
arrhythmias
· Essential
hypertension,
usually incombination with
other drugs
· Unlabeled uses:
Treatment of
hirsutism due to
its antiandrogenicproperties,
palliation of
symptoms of PMS,
treatment of
familial male
precocious
puberty, short-
term treatment of
acne vulgaris
Conraindications:
· allergy to
spironolactone,
hyperkalemia,
renal disease,
anuria, amiloride
or triamterene
use.
gynecomastia lactation, renal
disease,
electrolyte
imbalances
Theophylline
1.4 mg po
q12h
Relaxes smooth
muscle of
respiratory system
by blocking
phosphodiesterase, which increases
cAMP, which
increases
Indications:
· Bronchospasm of
COPD
· Bronchial asthma
· Chronic bronchitis
Contraindications:
· Hypersensitivity to
CNS: anxiety,
restlessness, insomnia,
dizziness, seizures,
headache, muscle
twitching, tremorsCV: palpitations, sinus
tachycardia, hypotension,
dysrhythmias
Breathe
without
difficulty
· monitor
theophylline
blood levels
· monitor I&O
· assess for signs
of toxicity:
irritability,
insomnia,
bronchodilation,
dieresis,
circulation, CNS
stimulation
xanthines
· tachydysrhythmias
ENDO: hyperglycemia
GI: nausea, vomiting,
anorexia, diarrhea, bitter
taste, gastric distressINTEG: flushing, urticaria
RESP: increased rate
restlessness,
tremors
· monitor
respiratory rate,
rhythm and
depth
· assess for
allergic reactions
Precautions:
· pregnancy,
elderly, CHF,
hepatic disease,
cor pulmonale,
hepatic disease,
DM,
hyperthyroidism,
hypertension
· ·