DRUGS MECHANISM OF INDICATION CONTRACTION ADVERSE EFFECT INTERACTION NURSING

ACTION CONSIDERATION
Drug Name: Drug to Drug: Before:
Cephalosporins inhibition of bacterial 1.Contraindicated in No Adverse effect Aminoglycosides: Produce  Determine history
cefuroxime exert bactericidal cell wall synthesis. patients hypersensitive seen on patient s synergistic activity of hypersensitivity re
(axetil) activity by Susceptible mild to to cefuroxime or other against some organisms; actions to
interfering with moderate infections cephalosporins. Use increases risk of cephalosporins,
bacterial cell wall including pharyngitis/t cautiously in breast- nephrotoxicity. Monitor penicillins, and
synthesis and onsillitis, acute feeding women and in patient closely. history of allergies,
inhibiting cross- maxillary sinusitis, patients with impaired Drug to Food: particularly to drugs,
Classification: linking of the chronic bronchitis, renal function or Any food: Increases before therapy is
Antibiotic peptidoglycan. The acute otitis media, penicillin allergy. absorption. Advise patient initiated.
cephalosporins are uncomplicated skin and to take drug with food.  Lab tests: Perform
also thought to play skin structure, UTIs, 2.Pharyngitis, Pharmacokinetics: culture and sensitivity
a role in the gonorrhea, early Lyme tonsillitis,infections of Absorption: tests before initiation
Clinical activation of disease the urinary andlower Cefuroxime sodium isn’t of therapy and
Significance: bacterical cell respiratory tracts, well absorbed from the GI periodically during
used to treat autolysins which andskin and skin- tract and must be given therapy if indicated.
infections of the may contribute to structureinfections parenterally. Cefuroxime Therapy may be
middle ear, bacterial cell lysis. caused byStreptococcus axetil is better absorbed instituted pending
sinuses, pneumoniaeand S. orally; between 37% and test results. Monitor
skin, tonsils, and pyogenes,Haemophillus 52% of an oral dose is periodically BUN and
throat influenzae,Staphylococ absorbed. Food appears to creatinine clearance.
cus aureus,Escherichia enhance absorption.
During:
Date ordered: coli. Distribution:
 Inspect IM and IV
January 26,2020 Distributed widely into
injection sites
most body tissues and
frequently for signs of
fluids, including the
phlebitis.
gallbladder, liver, kidneys,
 Monitor for
bone, bile, and pleural and
synovial fluids; CSF manifestations
penetration is greater than of hypersensitivity (se
that of most first- and e Appendix F).
second-generation Discontinue drug and
cephalosporins and report their
achieves adequate appearance promptly.
therapeutic levels in  Monitor I&O rates and
inflamed meninges. pattern: Especially
Cefuroxime crosses the important in severely
placental barrier and is ill patients receiving
33% to 50% protein- high doses. Report
bound. any significant
Metabolism: changes.
Not metabolized. After:
Excretion: Primarily  Instruct patient to
excreted in urine by renal take medication
tubular secretion and around the clock at
glomerular filtration; evenly spaced times
elimination half-life is 1 to and to finish the
2 hours in patients with medication
normal renal function; completely, even if
end-stage renal disease feeling better
prolongs half-life 15 to 22
 Advise patient to
hours. Some drug appears
report signs of
in breast milk.
superinfection and
Hemodialysis removes
allergy
cefuroxime.
 Instruct patient to
notify health
professional if fever
and diarrhea develop
 DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE EFFECT INTERACTION NURSING
OF ACTION CONSIDERATION
Drug Name: Drug to drug: • long term therapy may
Omeprazole is a Omeprazole oral Contraindicated in patients No adverse effect No to drug to drug casue vitamin B12
omeprazole selective and capsule is used to hypersensitive to drug or seen on patient interaction seen in the absorption problems.
(Losec , Prilosec) irreversible reduce the amount of its components. patient. Assess patient for sign and
proton pump acid in your stomach. Drug to Food: symptoms of
inhibitor. It It's used to treat gastric No to drug to food cyanocobalamin deficieny.
Dosage/Route: suppresses or duodenal ulcers, interaction seen in the
40 mg Oral stomach acid gastroesophageal reflux patient. • periodically assess patient
secretion by disease (GERD), Pharmacokinetics: for osteoporosis.
specific erosive esophagitis, and Absorption:
inhibition of the hypersecretory Omeprazole is acid-labile, • gastric level rises in most
Classification: H+/K+-ATPase conditions. This drug is and the formulation patients during the first 2
gastric acid system found at also used to treat contains enteric-coated weeks of therapy.
suppressant the secretory stomach infections granules that permit
surface of caused by Helicobacter absorption after drug • Drug increases its own
gastric parietal pylori bacteria. leaves the stomach. bioavailability with
Clinical cells.. Distribution: repeated doses. Drug is
Significance: About 95% protein-bound. unstable in gastric acid; less
used to treat Metabolism: drug is lost to hydrolysis
gastric acid- Primarily metabolized in because drug increases
related disorders. the liver. gastric pH.
Excretion:
Date ordered: Primarily excreted by the
January 26, 2020 kidneys. Plasma half-life is
1/2 to 1 hour, but drug
effects may persist for
days.
 DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE EFFECT INTERACTION NURSING
OF ACTION CONSIDERATION
Drug Name: Drug to drug: • Assess type, location, and
Tramadol acts Tramadol is used to Not recommended for No adverse effect No to drug to drug intensity of pain before and 2-
tramadol by binding to μ- treat moderate to severe those with hepatic seen on patient interaction seen in the 3 hr (peak)
hydrochloride opioid receptors pain. So the doctor give impairment. patient. after administration.
(Ultracet, Ultram) on neurons. It is tramadol because the Hypersensitivity to any Drug to Food:
also a serotonin– patient experience component of the product No to drug to food • Assess BP & RR before and
Dosage/Route: norepinephrine moderate pain. or to opiods. Use in acute interaction seen in the periodically
50mg Oral q8 (-) reuptake intoxication with alcohol, patient. duringadministration.
3x day inhibitor hypnotics, narcotics, Pharmacokinetics: Respiratorydepression has not
(SNRI). It is centrally acting analgesic, Absorption: occurredwith recommended
converted in the opioids, or psychotropic Almost completely doses.
Classification: liver to O- drugs. absorbed. Mean absolute
Analgesic desmethyltrama bioavailability of a 100-mg • Assess bowel function
dol, an opioid dose is about 75%. routinely. Prevention
Clinical with stronger Distribution: About 20% of constipation should
Significance: binding to the μ- bound to plasma protein; it beinstituted with increased
Tramadol is used opioid receptor. may cross the blood-brain intakeof fluids and bulk and
to treat both acute barrier. withlaxatives to
and chronic pain Metabolism: Extensively minimizeconstipating effects.
of moderate to metabolized.
(moderately) Excretion: About 30% of • Assess previous analgesic
severe intensity. a dose is excreted history. Tramadol is
unchanged in urine and notrecommended for
60% as metabolites. Half- patientsdependent on opioids
life of drug is about 6 to 7 or whohave previously
hours. receivedopioids for more than
1 wk;may cause opioid
withdrawalsymptoms.
 DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT INTERACTION NURSING
ACTION CONSIDERATION
Drug Name: Drug to drug:
The (ketorolac 1. Hypersensitivity to the No Adverse effect No to drug to drug interaction seen - Monitor Bp frequently.
ketorolac primary mechanis tromethamine) is drug or allergic symptoms seen on patient in the patient. Drug mask common
tromethamine m of indicated for the (angioedema, Drug to Food: signs and symptoms of
(Toradol) action responsible short-term ( ≤ 5 bronchospasm) to aspirin No to drug to food interaction seen shock.
for ketorolac's ant days) management or other NSAIDs. Active in the patient. - keep patient supine
Dosage/Route: i-inflammatory, of moderately peptic ulcer disease, recent Pharmacokinetics: while patient is receiving
30 mg Oral q8 antipyretic and severe GI bleeding or perforation, Absorption:I.M. form is completely I.V therapy. Monitor BP
analgesic effects acute pain that history of peptic ulcer absorbed. Food delays absorption of closely before allowing
Classification: is the inhibition of requires analgesia disease or GI bleeding. oral form but doesn’t decrease total patient to ambulate.
NSAID prostaglandin at the opioid level, amount of drug absorbed. - In diabetic patients,
analgesic synthesis by usually in a Distribution: More than 99% of monitor glucose level
competitive postoperative drug is protein-bound. closely because beta
Clinical blocking of the setting. Metabolism: Metabolism is blockers may mask
Significance: enzyme primarily hepatic; a para-hydroxy certain signs and
management of cyclooxygenase metabolite and conjugates have been symptoms of
moderately (COX). Ketorolac identified; less than 50% of a dose is hypoglycemia.
severe acute pain is a non-selective metabolized - Don’t routinely
that requires COX inhibitor. It Excretion: More than 90% is withdraw long-term beta
analgesia at the is considered a excreted in urine, the rest in feces. blocker therapy before
opioid level and first-generation Terminal plasma half-life is 33/4 to surgery.
only as NSAID. 61/3 hours (average 41/2 hours) in
continuation young adults; it’s substantially
treatment prolonged in patients with renal
following IV or failure.
IM dosing

Date Ordered:
January 26, 2020
 DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT INTERACTION NURSING
ACTION CONSIDERATION
Drug Name: Drug to drug:
 - Correct volume
It plays a role in used to treat 1.Contraindication IM, No Adverse effect No to drug to drug interaction seen
depletion before initiating
Calcium normal cardiac conditions arising intramyocardial, or SC seen on patient in the patient.
drug. Observe for
gluconate function, renal from calcium due to severe tissue Drug to Food:
hypotension during
function, deficiencies the necrosis, sloughing, and No to drug to food interaction seen
therapy.
respiration, blood patient was given abscess formation. in the patient.
Dosage/Route: coagulation, and an calcium Pharmacokinetics:  - Be aware that because
1anp oral cell membrane gluconate to treat Absorption: Oral dose is absorbed of the drug’s mechanism
and capillary the possible rising actively in the duodenum and of action, urine test will
permeability. of calcium proximal jejunum and, to a lesser be positive for glucose.
Also, calcium hel deficiencies. extent, in the distal part of the small
 - monitor electrolytes,
Classification: ps to regulate the intestine.
Calcium salt release and Distribution: Enters the such as potassium and
storage of extracellular fluid and is magnesium correct levels
Clinical neurotransmitters incorporated rapidly into skeletal as clinically indicated.
Significance: and hormones, the tissue. Bone contains 99% of the  - Drug may increase lipid
As a medication uptake and total calcium; 1% is distributed levels. Assess LDL
it is used by binding of amino equally between the intracellular and cholesterol level
injection into a acids, absorption extracellular fluids. CSF levels are periodically and treat
vein to treat low of vitamin B 12, about 50% of serum calcium levels. appropriately.
blood calcium, and gastrin Metabolism: None significant.
high blood secretion. Excretion: Excreted mainly in the 
potassium, and feces as unabsorbed calcium that was
magnesium secreted through bile and pancreatic
toxicity. juice into the lumen of the GI tract.
 DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE INTERACTION NURSING
OF ACTION EFFECT CONSIDERATION
Drug Name: Drug to drug: • Assess type, location, and
Tramadol acts by Tramadol is used to Not recommended for No Adverse effect No to drug to drug interaction seen intensity of pain before and
tramadol binding to μ-opioid treat moderate to those with hepatic seen on patient in the patient. 2-3 hr (peak)
hydrochloride receptors on severe pain. So the impairment. Drug to Food: after administration.
(Ultracet, Ultram) neurons. It is also a doctor give Hypersensitivity to any No to drug to food interaction seen
serotonin– tramadol because component of the product in the patient. • Assess BP & RR before
Dosage/Route: norepinephrine the patient or to opiods. Use in acute Pharmacokinetics: and
50mg IV q6 reuptake inhibitor experience intoxication with alcohol, Absorption: periodically
(SNRI). It is moderate pain. hypnotics, narcotics, Almost completely absorbed. duringadministration.
converted in the centrally acting analgesic, Mean absolute bioavailability of a Respiratorydepression has
Classification: liver to O- opioids, or psychotropic 100-mg dose is about 75%. not occurredwith
Analgesic desmethyltramadol, drugs. Distribution: About 20% bound to recommended doses.
an opioid with plasma protein; it may cross the
Clinical stronger binding to blood-brain barrier. • Assess bowel function
Significance: the μ-opioid Metabolism: Extensively routinely. Prevention
Tramadol is receptor. metabolized. of constipation should
used to treat both Excretion: About 30% of a dose is beinstituted with increased
acute and chronic excreted unchanged in urine and intakeof fluids and bulk and
pain of moderate 60% as metabolites. Half-life of withlaxatives to
to (moderately) drug is about 6 to 7 hours. minimizeconstipating
severe intensity. effects.

Date ordered: • Assess previous analgesic

January 26, 2020 history. Tramadol is
notrecommended for
patientsdependent on
opioids or whohave
previously receivedopioids
for more than 1 wk;may
cause opioid
withdrawalsymptoms.
 DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT INTERACTION NURSING
ACTION CONSIDERATION
Drug Name: Drug to drug: Before:
Cephalosporins inhibition of bacterial 1.Contraindicated in No Adverse effect No to drug to drug  Determine history
cefuroxime exert bactericidal cell wall synthesis. patients hypersensitive to seen on Patient interaction seen in the of hypersensitivity reacti
(axetil) activity by Susceptible mild to cefuroxime or other patient. ons to cephalosporins,
interfering with moderate infections cephalosporins. Use Drug to Food: penicillins, and history
bacterial cell wall including pharyngitis/t cautiously in breast- No to drug to food of allergies, particularly
synthesis and onsillitis, acute feeding women and in interaction seen in the to drugs, before therapy
inhibiting cross- maxillary sinusitis, patients with impaired patient. is initiated.
Classification: linking of the chronic bronchitis, renal function or penicillin Pharmacokinetics:  Lab tests: Perform
Antibiotic peptidoglycan. acute otitis media, allergy. Absorption: culture and sensitivity
The uncomplicated skin Cefuroxime sodium isn’t tests before initiation of
cephalosporins and skin structure, 2.Pharyngitis, well absorbed from the GI therapy and periodically
are also thought UTIs, gonorrhea, early tonsillitis,infections of the tract and must be given during therapy if
Clinical to play a role in Lyme disease urinary andlower parenterally. Cefuroxime indicated. Therapy may
Significance: the activation of respiratory tracts, andskin axetil is better absorbed be instituted pending test
used to treat bacterical cell and skin- orally; between 37% and results. Monitor
infections of the autolysins which structureinfections caused 52% of an oral dose is periodically BUN and
middle ear, may contribute to byStreptococcus absorbed. Food appears to creatinine clearance.
sinuses, bacterial cell pneumoniaeand S. enhance absorption. During:
skin, tonsils, and lysis. pyogenes,Haemophillus Distribution:  Inspect IM and IV
throat. influenzae,Staphylococcus Distributed widely into injection sites frequently
aureus,Escherichia coli. most body tissues and for signs of phlebitis.
Date ordered: fluids, including the  Monitor for
January 26, 2020 gallbladder, liver, kidneys, manifestations
bone, bile, and pleural and of hypersensitivity (see
synovial fluids; CSF Appendix F).
penetration is greater than Discontinue drug and
that of most first- and report their appearance
second-generation promptly.
cephalosporins and  Monitor I&O rates and
achieves adequate pattern: Especially
therapeutic levels in important in severely ill
inflamed meninges. patients receiving high
Cefuroxime crosses the doses. Report any
placental barrier and is significant changes.
33% to 50% protein- After:
bound.  Instruct patient to take
Metabolism: medication around the
Not metabolized. clock at evenly spaced
Excretion: Primarily times and to finish the
excreted in urine by renal medication completely,
tubular secretion and even if feeling better
glomerular filtration;  Advise patient to report
elimination half-life is 1 to signs of superinfection
2 hours in patients with and allergy
normal renal function;  Instruct patient to notify
end-stage renal disease health professional if
prolongs half-life 15 to 22 fever and diarrhea
hours. Some drug appears develop
in breast milk.
Hemodialysis removes
cefuroxime.
 DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE INTERACTIONS NURSING
OF ACTION EFFECT CONSIDERATION

Drug Drug to drug:

Name: Exerts Doxycycline is Contraindicated in patient No adverse effect seen No to drug to drug interaction seen - Cutaneous anthrax with
bacteriostatic indicated for the hypertensive to drug or on patient. in the patient. signs of systemic
Doxycycline effect by treatment of other tetracyclines. Drug to Food: involvement, extensive
binding to the various No to drug to food interaction seen edema, or lesion on head or
30s and infections by in the patient. neck requires I.V therapy and
Dosage/ possibly 50s gram-positive Pharmacokinetics: a multidrug approach.
Route: ribosomal and gram- Absorption: About 90% to 100%
100mg 1Tb oral subunits of negative is absorbed after oral - check patient tongue for
BID x 1u days microorganisms bacteria, administration. Doxycycline has signs of fungal infection.
and inhibiting aerobes and the least affinity for calcium of all
Classification: protein anaerobes, as tetracyclines; its absorption is - photosensitivity reactions
Tetracycline, synthesis well other types insignificantly altered by milk or may occur within a few
Antibiotic of bacteria. other dairy products. minutes to several hours after
Distribution: Distributed widely exposure and may last after
Clinical into body tissues and fluids, therapy ends.
Significance: including synovial, pleural,
is an antibiotic prostatic, and seminal fluids;
used in the bronchial secretions; saliva; and
treatment of aqueous humor. CSF penetration is
infections poor. Doxycycline readily crosses
caused by the placental barrier, and is 25% to
bacteria and 93% protein-bound.
certain Metabolism: Insignificantly
parasites. metabolized; some hepatic
degradation occurs.
Date ordered: Excretion: Excreted primarily
January 27,2020 unchanged in urine by glomerular
filtration; some may be excreted in
breast milk.
 DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE INTERACTION NURSING
ACTION EFFECT CONSIDERATION
Drug
Name: Ascorbic acid is Used to treat vitamin Vitamin C No Adverse effect Drug to drug:
Ascorbic Acid reversibly oxidized C deficiency, scurvy, supplementation is seen on patient No to drug to drug • Lab tests: Periodic
to dehydroascorbic delayed wound and contraindicated in blood interaction seen in the Hct & Hgb, serum
Dosage/ acid in the body. bone healing, urine disorders like patient. electrolytes.
Route: These two forms of acidification, and in thalassemia, G6PD Drug to Food:
1 oral the vitamin are general as an deficiency, sickle cell No to drug to food • Monitor for S&S of
believed to be antioxidant. It has disease, interaction seen in the acute hemolytic
Classification: important in also been suggested and hemochromatosis. patient. anemia, sickle cell
antioxidant. oxidation-reduction to be an effective Avoid taking supplements Pharmacokinetics: crisis.
reactions. The antiviral agent. immediately before or Absorption: After oral
Clinical vitamin is involved following angioplasty. administration, ascorbic acid • Ascorbic acid
Significance: in tyrosine is absorbed readily. After shouldn’t be used for
is an antibiotic used metabolism, very large doses, absorption 48 to 72 hours
before an amine-
in the treatment of conversion of folic may be limited because
dependent test for
infections caused by acid to folinic acid, absorption is an active occult blood in the
bacteria and certain carbohydrate process. stool is conducted. A
parasites. metabolism, Distribution: Distributed false-negative result
synthesis of lipids widely in the body, with may occur.
Date ordered: and proteins, iron large concentrations found
January 27, 2020 metabolism, in the liver, leukocytes, • Administer oral
resistance to platelets, glandular tissues, solutions of ascorbic
acid directly into the
infections, and and lens of the eye.
mouth or mix with
cellular respiration. Metabolism: Metabolized food.
in the liver.
Excretion: Reversibly
oxidized to dehydroascorbic
acid. Some is metabolized to
inactive compounds that are
excreted in urine.
 DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE INTERACTION NURSING
ACTION EFFECT CONSIDERATION
Drug
Name: As these receptors For the treatment of Inflammatory intestinal No adverse effect Drug to drug:
have a role as a major rheumatoid arthritis, diseases. Active peptic seen on patient. No to drug to drug -Assess patients who
Mefenamic Acid mediator of osteoarthritis, ulcers. Hypersensitivity to interaction seen in the develop severe
inflammation and/or a dysmenorrhea, and aspirin (acetylsalicylic patient. diarrhea and vomiting
role for prostanoid mild to moderate acid) or other non- Drug to Food:
for dehydration and
Dosage/ Route: signaling in activity- pain, inflammation, steroidal anti- No to drug to food
500 mg 1 Tb q6 dependent plasticity, and fever. inflammatory agents. interaction seen in the electrolyte imbalance.
the symptoms of pain Renal failure. patient. -Lab tests: With long-
are temporarily Pharmacokinetics:
term therapy (not
Classification: reduced. Absorption:
(NSAIDs) Mefenamic acid is recommended) obtain
rapidly absorbed after periodic complete
oral administration. blood counts, Hct and
Clinical Distribution: 1.06
Significance; L/kg [Normal Healthy Hgb, and kidney
Adults (18-45 yr)] function tests.
Treatment for mild to Metabolism:
moderate pain The activity of these
inflammation and metabolites has not
fever. been studied.
Mefenamic acid is
Date ordered: also glucuronidated
January 27, 2020 directly.
 DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE INTERACTION NURSING
ACTION EFFECT CONSIDERATION
Drug Drug to drug:
Name: Paracetamol has a Paracetamol has good (None except No Adverse No to drug to drug - Check that the patient
Paracetamol central analgesic effect analgesic and hypersensitivity to effect seen on interaction seen in the is not taking any other
that is mediated through antipyretic properties. paracetamol). patient patient. medication containing
Dosage/ activation of descending It is suitable for Drug to Food: paracetamol.
Route: serotonergic pathways. the treatment of pains No to drug to food - For children who may
Debate exists about its refuse medicine off a
1g q8 of all kinds interaction seen in the
primary site of action,
(headaches, patient. spoon try using a
which may be inhibition
Classification: of prostaglandin (PG) dental pain, Pharmacokinetics: medicine syringe to
nonnarcotic synthesis or through an postoperative pain, pai Absorption: After oral squirt liquid slowly into
analgesic, active metabolite n in connection administration, ascorbic the side of the child’s
antipyretic influencing cannabinoid with colds, post- acid is absorbed readily. mouth or use soluble
receptors traumatic After very large doses, paracetamol mixed with
Clinical muscle pain). absorption may be limited a drink.
Significance: because absorption is an - Some children may be
Paracetamol (acet active process. happy to take one
aminophen) is a Distribution: Distributed paracetamol product but
pain reliever and a widely in the body, with dislike the taste of
fever reducer. large concentrations another.
found in the liver,
Date ordered: leukocytes, platelets, - There are no known
January 27, 2020 glandular tissues, and lens harmful effects when
of the eye. used during pregnancy.
Metabolism: Metabolize - Small amounts may
d in the liver. pass into breast milk.
Excretion: Reversibly However, there are no
oxidized to known harmful effects
dehydroascorbic acid. when used by
Some is metabolized to breastfeeding mothers.
inactive compounds that
are excreted in urine.