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Generic Name: Flucloxacillin
Trade Name: Flopen (Aspen) / Floxapen (GSK) / Fluclox (ACI) / Softapen / Staphylex
Classification: Narrow-spectrum beta-lactam antibiotic of the penicillin class
Mode of action: Flucloxacillin, by its action on the synthesis of the bacterial wall, exerts a
bactericidal effect on streptococci, staphylococci, including the beta-lactamase-producing strains,
clostridia and neisseria. It is not active against methicillinresistant staphylococci.
Method of administration: The usual routes of administration for Flucloxacillin 250mg, 500mg
and 1g Powder for Solution for Injection or Infusion are by slow intravenous injection and
intravenous infusion. Flucloxacillin 250mg and 500mg Powder for Solution for Injection or
Infusion may also be administered by intramuscular, intra-articular or intrapleural injection.
Flucloxacillin 250mg may also be inhaled by nebuliser.
Side Effects:
Hypersensitivity reactions: rare in neonates. May present as erythema and rash
(maculopapular rash, red purple plaques or urticarial type plaques8-11
Blood pathology: anaemia, thrombocytopaenia and leucopoenia1
Digestive: severe hepatitis and cholestatic jaundice, which may be protracted1 vomiting,
diarrhoea, GI upset
Integumentary: irritative effects: phlebitis and venous irritation5
Reports of hepatic reactions, pseudomembranous colitis, erythema multiforme, StevensJohnson syndrome, toxic epidermal necrolysis.
Indication: Treatment of infections due to susceptible gram-positive organisms (typically
pneumonia, osteomyelitis, skin and soft tissue infections, infected burns, and cellulitis1)
• Skin and soft tissue infections: boils, abscesses, carbuncles, furunculosis, cellulitis, infected
wounds, infected burns, protection of skin grafts, and impetigo.
• Infected skin conditions: ulcer, eczema and acne.
• Respiratory tract infections: Pneumonia, lung abscess, empyema, sinusitis, pharyngitis,
tonsillitis, quinsy, otitis media and externa.
• Other infections caused by flucloxacillin-sensitive organisms such as osteomyelitis, enteritis,
endocarditis, urinary tract infection, meningitis, septicaemia.
Contraindications: History of flucloxacillin-associated jaundice/hepatic dysfunction.
Hypersensitivity to other β-lactams.
Special Precautions:
Caution on Jaundiced neonates
Pregnancy, Lactation
IM route only if IV not possible (IM painful)
UAC route: discuss with neonatologist/paediatrician prior to use
If co-prescribed with aminoglycosides, administer separately (separate administration by
1 hour, separate injection site/line or flush well between medicines
Caution for hepatic dysfunction, severe renal impairment (CrCl<10ml/min). Risk of acute
generalised exanthematous pustulosis
Age ≥50 years, serious underlying disease.
Nursing Responsibilities:
Monitor renal and hepatic function during prolonged treatment. Flucloxacillin should be given
with caution to patients with a history of allergy, especially to drugs. Before initiating therapy
with flucloxacillin, careful inquiry should be made concerning previous hypersensitivity
reactions to ß-lactams. Care is necessary if very high doses of flucloxacillin are given, especially
if renal function is poor, because of the risk of nephrotoxicity and/or neurotoxicity. The
intrathecal route should be avoided. Care is also necessary if large doses of sodium salts are
given to patients with impaired renal function or heart failure. Flucloxacillin should be used with
caution in patients with evidence of hepatic dysfunction (see section 4.8). Renal, hepatic and
haematological status should be monitored during prolonged and high-dose therapy (e.g.
osteomyelitis, endocarditis). Prolonged use may occasionally result in overgrowth of nonsusceptible organisms. Care is required when treating some patients with spirochaete infections
such as syphilis or leptospirosis because the Jarisch- Herxheimer reaction may occur shortly after
treatment with a penicillin is started. Caution is advised when flucloxacillin is administered
concomitantly with paracetamol due to the increased risk of high anion gap metabolic acidosis
(HAGMA). Patients at high risk for HAGMA are in particular those with severe renal
impairment, sepsis or malnutrition especially if the maximum daily doses of paracetamol are
Generic name: Paracetamol
Brand name: Tempra/ Calpol/ Biogesic
Classification: Analgesics, non-opioids, and antipyretics
Mode of action: Decreases fever by inhibiting the effects of pyrogens on the hypothalamus heat
regulating centers & by a hypothalamic action leading to sweating & vasodilatation. Relieves
pain by inhibiting prostaglandin synthesis at the CNS but does not have anti-inflammatory action
because of its minimal effect on peripheral prostaglandin synthesis.
Method of administration: PO
Side Effects: Stimulation, drowsiness, nausea, vomiting, abdominal pain, hepatotoxicity, hepatic
seizure(overdose, Renal failure(high, prolonged doses), leucopenia, neutropenia, hemolytic
anemia (long term use) thrombocytopenia, pancytopenia, rash, urticaria, hypersensitivity,
cyanosis, anemia, jaundice, CNS, stimulation, delirium followed by vascular collaps,
convulsions, coma, death.
Indication/s: Relief of mild-to-moderate pain; treatment of fever.
Patients with:
Intolerance to tartrazine (yellow dye #5), alcohol, table sugar, saccharin
Contraindicated with allergy to acetaminophen
Nursing Responsibilities and Special Precautions
Assess patient’s fever or pain: typeof pain, location, intensity, duration, temperature, and
Assess allergic reactions: rash, urticaria; if these occur, drug may have to be
Teach patient to recognize signs of chronic overdose: bleeding, bruising, malaise, fever,
sore throat.
Tell patient to notify prescriber for pain/ fever lasting for more than 3 days.
Before giving drug, ask patient/parents if he is allergic to penicillins or cephalosporin.
Obtain specimen for C/S test before giving first dose.
For IM use, inject deep into a large muscle, such as gluteus maximus or the side of the
Absorption of oral drug is enhanced by food.
Tablets may be crushed, if absolutely necessary, for patient who can’t swallow tablets.
Tablets can be dissolved in juices, chocolate or milk, however, the drug has a bitter taste
that is difficult to mask, even with food. -Don’t confuse drug with other cephalosporins
that sound alike.
Tell patient to take drug as prescribed, even after he feels better.
Instruct patient to take oral form with food.
Instruct patient to notify prescriber about rash, loose stool, diarrhea or evidence of
Generic name: metoclopramide
Trade names: Primperan, Reglan, Maxolon, Clopra, Metozolv Classification: Metoclopramide
is in a class of medications called prokinetic agents. It works by speeding the movement of food
through the stomach and intestines.
Mechanism of action: The antiemetic action of metoclopramide is due to its antagonist activity
at D2 receptors in the chemoreceptor trigger zone in the central nervous system — this action
prevents nausea and vomiting triggered by most stimuli. At higher doses, 5-HT3 antagonist
activity may also contribute to the antiemetic effect.
Indications: Metoclopramide is a medication used mostly for stomach and esophageal problems.
It is commonly used to treat and prevent nausea and vomiting, to help with emptying of the
stomach in people with delayed stomach emptying, and to help with gastroesophageal reflux
disease. It is also used to treat migraine headaches.
Contraindications: Metoclopramide is contraindicated in pheochromocytoma. It should be used
with caution in Parkinson’s disease as a dopamine antagonist, it may worsen symptoms. Side
effects: Drowsiness, dizziness, tiredness, trouble sleeping, agitation, headache, and diarrhea may
occur. If any of these effects persist or worsen.
Nursing Responsibilities and Special Precautions
This medication may make you drowsy. Do not drive a car or operate machinery until you know
how this medication affects you. Tell the doctor if you have or have ever had blockage, bleeding,
or a tear in your stomach or intestines; pheochromocytoma (tumor on a small gland near the
kidneys); or seizures. Your doctor will probably tell you not to take metoclopramide. Tell the
doctor and pharmacist if you are allergic to metoclopramide, any other medications, or any of the
ingredients in metoclopramide tablets or solution Nursing responsibilities: Assess for
extrapyramidal symptoms and tardive dyskinesia (more likely in older patients). Assess for
gastrointestinal complaints, such as nausea, vomiting and constipation. In oral administration, for
better absorption allow 30 minutes to one hour before eating. Rinse mouth frequently to combat
dryness. Teach the patient that metoclopramide can cause drowsiness. Patient should avoid
hazardous activities until stabilized.
Generic name: Albuterol
Trade name: Proventil, ProAir
Classification: Oral Beta-2 Agonists, Respiratory Short-Acting Beta-2 Agonists (SABA)
Mechanism of Action: The mechanism of action for albuterol is essentially relaxing the smooth
muscles of the airways. It activates the beta2-adrenergic receptors in the lungs, which begins a
cascade of actions that result in bronchodilation.
Indications: Ventolin (albuterol) is a bronchodilator that relaxes muscles in the airways and
increases air flow to the lungs. Ventolin HFA is used to treat or prevent bronchospasm, or
narrowing of the airways in the lungs, in people with asthma or certain types of chronic
obstructive pulmonary disease (COPD).
Contraindications: Ventolin is contraindicated in patients with a history of hypersensitivity to
any of the ingredients.
Side effects: Nervousness, shaking (tremor), headache, mouth/throat dryness or irritation,
changes in taste, cough, nausea, dizziness, anxiety, muscle cramps, and palpitation.
Special precautions: This product may contain inactive ingredients, which can cause allergic
reactions or other problems. Before using this medication, tell the doctor or pharmacist your
medical history, especially of: heart problems (such as irregular heartbeat, angina, heart attack),
high blood pressure, seizure. This drug may make you dizzy. Do not drive, use machinery, or do
anything that needs alertness until you can do it safely. Limit alcoholic beverages.
Nursing responsibilities: Before administration, the nurse must always validate his/her patient’s
information. Since the medication is taken via nebulization, make sure that the mist is properly
inhaled by the patient.
Kizior, R. J., & Hodgson, B. B. (2017). Saunders Nursing Drug Handbook 2018-E-Book.
Elsevier Health Sciences. Retrieved from
Flucloxacillin sodium. (2018). MIMS Online. Retrieved from: https://www.mimsonline.com.au.
Paracetamol. (2020). Drugs.com. Retrieved from https://www.drugs.com/paracetamol.html