A. DRUG STUDY
Classification
Therapeutic
actions
Brand Name:
ApoMetronidazole
(CAN), Flagyl,
Flagyl 375,
Flagyl ER,
Flagyl IV,
Flagyl IV RTU,
MetroCream
(CAN),
MetroGel,
Metro I.V.,
Neo-Tric
(CAN), NidaGel
(CAN),
Noritate,
Novonidazol
(CAN), PMSMetronidazole
(CAN),
Protostat,
Trikacide
(CAN)
Bactericidal:
inhibits DNA
synthesis in
specific
(obligate)
anaerobes,
causing cell
death;
antiprotozoaltrichomonacidal,
amebicidal:
biochemical
mechanism of
action is not
known.
Pregnancy
Category B
Indications
· Acute infection
with susceptible
anaerobic bacteria
· Acute intestinal
amebiasis
· Amebic liver
abscess
· Trichomoniasis
Trichomoniasis
(acute and partners
of patients with
acute infection)
· Preoperative,
Preoperative,
intraoperative,
postoperative
prophylaxis for
patients undergoing
colorectal surgery
· Topical application
in the treatment of
inflammatory
papules, pustules,
and erythema of
rosacea
· Unlabeled uses:
Contraindications
· Contraindicated with
hypersensitivity
hypersensitiv
ity to
metronidazole;
pregnancy (do not use
for trichomoniasis in
first trimester).
· Use cautiously with
CNS diseases, hepatic
disease, candidiasis
(moniliasis), blood
dyscrasias, lactation.
Dosages
IV
Metronidazole
Dosage for
Anaerobic
Infections
For serious
anaerobic
infections,
metronidazole
metronidazol
e is
usually given by
IV in a hospital
(at least at first).
For the oral
forms, the
recommended
dose for treating
anaerobic
infections is
based on
weight: 7.5 mg
per kg of body
weight (about
3.4 mg per
pound) every 6
hours, up to a
maximum of
4000 mg in any
given 24-hour
period. The
medication is
Adverse effects
Nursing
Responsibility
Headache, dizziness,
ataxia, vertigo,
incoordination,
insomnia, seizures,
peripheral
neuropathy, fatigue
· Avoid use
unless
necessary.
Metronidazole is
carcinogenic in
some rodents.
Unpleasant metallic
taste, anorexia,
nausea, vomiting,
diarrhea, GI upset,
cramps
· Administer oral
doses with food.
Dysuria,
incontinence,
darkening of the
urine
Thrombophlebitis
(IV); redness,
burning, dryness,
and skin irritation
(topical)
Severe, disulfiramlike interaction with
alcohol, candidiasis
(superinfection)
· Apply topically
(MetroGel,
MetroCream)
after cleansing
the area. Advise
patient that
cosmetics may
be used over the
area after
application.
· Reduce dosage
in hepatic
disease.
Drug classes:
Antibiotic,
Antibacterial,
Amebicide,
Antiprotozoal
prophylaxis for
patients undergoing
gynecologic,
abdominal surgery;
usually taken for
7 to 10 days,
although some
infections may
hepatic
encephalopathy;
Crohn's disease;
antibioticassociated
pseudomembranous
colitis; treatment of
Gardnerella
vaginalis, giardiasis
(use recommende
recommended
d
require
extended
treatment.
by the CDC)
dysentery, the
recommended
metronidazole
dose is 750 mg
three times a
day for 5 to 10
days. For an
amebic liver
abscess, the
recommended
Oral Dose for
Amebic
Infections
For amebic
dose is 250 to
500 mg three
times daily for 5
to 10 days. For
treating amebic
infections in
children, your
child's
healthcare
provider will
calculate an
appropriate
amount based
on your child's
weight.
Classification
Protexin
Probiotics
Therapeutic
actions
Many people use
probiotics to
prevent diarrhea,
gas, and cramping
caused by
antibiotics.
Antibiotics kill
"good" (beneficial)
bacteria along with
the bacteria that
cause illness. A
decrease in
beneficial bacteria
may lead to
digestive
problems. Taking
probiotics may
help replace the
lost beneficial
bacteria. This can
help prevent
diarrhea.
Indications
Contraindicati
Contraindications
ons
Dosages
Adverse effects
Nursing
Responsibility
Probiotics, or
friendly or
good bacteria,
are live
microorganisms
that can be
used as
complementary
and alternative
medicine to
treat illnesses
such as vaginal
infections,
tooth decay, H.
pylori infection,
irritable bowel
syndrome,
infectious
diarrhea, and
inflammatory
bowel diseases
like ulcerative
colitis and
Crohn's
disease.
For people with
suppressed immune
systems due to disease
or treatment for a
disease (such as cancer
chemotherapy),, taking
chemotherapy)
probiotics may actually
increase your chances
of getting sick. Always
speak with your doctor
before taking any
supplement under
these circumstances
circumstances..
2 cap/chewable
tab daily or 1
sachet daily.
Probiotics are often
regulated as
dietary
supplements rather
than as
pharmaceuticals or
biological products.
Thus, there is
usually no
requirement to
demonstrate
safety, purity, or
potency before
marketing
probiotics.
Check for signs of
hypersensitivity
Infection
Reports of sepsis
related to probiotic
use
Risk factors for
probiotic sepsis
A decrease in
beneficial bacteria
Deleterious
may also lead to
metabolic activities
other infections,
such as vaginal
yeast and urinary
tract infections,
and symptoms
such as diarrhea
Immune deviation
or excessive
immune
stimulation
from intestinal
illnesses.
Probiotics may also
be used to:
Help with other
causes of diarrhea.
Help prevent
infections in the
digestive tract.
Help control
immune response
(inflammation), as
in inflammatory
bowel disease
(IBD).
Microbial
resistance
Classification
Generic Name:
Paracetamol,
Therapeutic
actions
Decreases
fever by a
Acetaminophen hypothalamic
Brand Name:
Biogesic,
Panadol,
Antipyretic
Analgesicantipyretic in
patients with
aspirin allergy,
Dosages
Adverse effects
Contraindicated with
allergy to
acetaminophen. Use
cautiously with
impaired hepatic
function, chronic
alcoholism,
pregnancy, lactation.
PO or PR By
suppository,
CNS: Headache
325–650 mg q
CV: Chest pain,
4–6 hr or PO,
dyspnea, myocardial
1,000 mg tid to
damage when doses of
qid.
5–8 g/day are ingested
Do not exceed 4
daily for several weeks
diatheses, upper
g/day.
or when doses of 4
GI disease, gouty
PEDIATRIC
g/day are ingested for 1
arthritis Arthritis
PATIENTS PO or
yr
and rheumatic
PR Doses may
disorders
be repeated 4–5
GI: Hepatic toxicity and
involving
times/day; do
failure, jaundice
musculoskeletal
not exceed five
pain (but lacks
doses in 24 hr;
GU: Acute kidney
Inhibits CNS
clinically
give PO or by
failure, renal tubular
prostaglandin
significant
suppository.
necrosis
to sweating
hemostatic
and
disturbances,
vasodilation
bleeding
Inhibits
analgesic,
Contraindications
pyrogen effect
on the
hypothalamicheatregulating
centers
Nursing
Responsibility
effect leading
Tylenol
Classification:
Non-narcotic
Indications
antirheumatic
synthesis with
minimal
and anti-
Age Dosage
Hematologic:
effects on
inflammatory
(mg)
Methemoglobinemia —
peripheral
effects) Common
0–3 mo 40
cyanosis; hemolytic
prostaglandin
cold, flu, other
4–11 mo 80
anemia—hematuria,
synthesis
viral and
12–23 mo 120
anuria; neutropenia,
bacterial
2–3 yr 160
leukopenia,
Does not
infections with
4–5 yr 240
pancytopenia,
cause
pain and fever
6–8 yr 320
thrombocytopenia,
Assessment
History: Allergy
to
acetaminophen,
impaired hepatic
function, chronic
alcoholism,
pregnancy,
lactation
Physical: Skin
color, lesions; T;
liver evaluation;
CBC, LFTs, renal
function tests
Interventions
Do not exceed
the
recommended
dosage. Consult
physician if
needed for
children < 3 yr; if
needed for
longer than 10
days; if continued
fever, severe or
recurrent pain
occurs (possible
serious illness).
ulceration of
Unlabeled use:
9–10 yr 400
the GI tract
Prophylactic for
11 yr 480
and causes no
children receiving
Hypersensitivity: Rash,
anticoagulant
DPT vaccination
fever
action.
to reduce
incidence of fever
and pain
hypoglycemia
Avoid using
multiple
preparations
containing
acetaminophen.
Carefully check
all OTC products.
Give drug with
food if GI upset
occurs.
Discontinue drug
if hypersensitivi
hypersensitivity
ty
reactions occur.
Treatment of
overdose:
Monitor serum
levels regularly,
N-acetylcysteine
should be
available as a
specific antidote;
basic life support
measures may be
necessary.
Teaching points
Do not exceed
recommended
dose; do not take
for longer than
10 days. Take the
drug only for
complaints
indicated; it is not
an antiinflammatory
agent. Avoid the
use of other overthe-counter
preparations.
They may contain
acetaminophen,
and serious
overdosage can
occur. If you need
an over-thecounter
preparation,
consult your
health care
provider. Report
rash, unusual
bleeding or
bruising,
yellowing of skin
or eyes, changes
in voiding
patterns.
Classification
Therapeutic
actions
Generic
Name:
Zn sulfate
monohydrate
E-Zinc contains
Brand Name:
E-Zinc® [drops
zinc. Zinc helps
the body's
natural defense
against damaging
free radicals
(antioxidant
effect) and helps
boost immune
function. Free
radicals are
highly reactive
and unstable
chemicals
Indications
Dietary
supplementation;
supplement to IV
solutions given
for TPN;
treatment or
prevention of
zinc deficiencies.
Ophthalmic
solution used as
mild astringent
for relief of eye
irritation.
Contraindications
HIV (human
Dosages
BY MOUTH:
immunodeficiency
virus)/AIDS: Do not
virus)/AIDS:
take zinc if you have
HIV/AIDS. Zinc
might shorten your
life.
For treating the
common cold: one
zinc gluconate or
acetate lozenge,
providing 9-24 mg
elemental zinc,
Allergy to any
dissolved in the
component of E-
mouth every two
Zinc.
hours while awake
Adverse effects
Taking high
Tell patient to
amounts of zinc is
contact health
LIKELY UNSAFE.
UNSAFE.
care provider if
High doses above
nausea, severe
the recommended
recommended
vomiting,
amounts might
dehydration, or
cause fever,
restlessness
coughing, stomach
occurs.
pain, fatigue, and
Identify food
many other
problems.
when cold
symptoms are
present.
Nursing
Responsibility
sources of zinc
(eg, seafood,
Taking more than
100 mg of
organ meats,
wheat germ).
generated during
For diarrhea in
supplemental zinc
Inform patient
normal body
malnourished or
daily or taking
that sense of
taste and smell,
activities that
zinc-deficient
supplemental zinc
require oxygen
children: 10-40 mg
for 10 or more years
skin hydration,
(eg, respiration,
digestion, blood
elemental zinc daily.
doubles the risk of
developing prostate
and wound
circulation,
For preventing and
cancer. There is also
treating pneumonia
improve.
immune system
concern that taking
response, etc)
in undernourished
large amounts of a
Instruct patient
and after
children in
multivitamin plus a
to follow RDA
exposure to
developing
separate zinc
guidelines and
ultraviolet (UV)
countries: 10-70
supplement
limitations in
increases the
terms of vitamin
light, cigarette
healing should
smoke and
mg/day.
various
pollutants. One
major effect of
For hypogeusia
chance of dying
and mineral
from prostate
supplementation.
cancer.
(sense of taste is
Tell patient to
abnormal): 25-100
mg zinc.
Taking 450 mg or
properly
For the eating
can cause problems
replicate the
disorder anorexia
with blood iron.
deoxyribonucleic
nervosa: 100 mg of
Single doses of 10-
acid(DNA), which
zinc gluconate daily.
30 grams of zinc can
zinc is on the
ability of cells to
is required for
cells to multiply.
more of zinc daily
be fatal
take with food if
GI upset occurs,
but to avoid
foods high in
calcium,
phosphorus, and
phytate. Inform
For treating stomach
patient that bran,
ulcers: zinc sulfate
caffeine, and
Hence, zinc is
needed for
200 mg three times
dairy products
normal growth.
daily.
may decrease
Zinc has other
known
functions/effects:
Cofactor of
various enzymes
in cell division
absorption.
For muscle cramps
in zinc deficient
Tell patient to
people with liver
notify health care
disease: zinc sulfate
provider if
220 mg twice daily.
change in vision
occurs or if eye
and growth.
Required for the
For osteoporosis: 15
mg zinc combined
irritation or pain
persists or
normal
with 5 mg
increases while
development
developme
nt and
manganese, 1000
using ophthalmic
maintenance of
mg calcium, and 2.5
solution.
the immune
mg copper has been
system; helps
used.
activity of cells
Advise patient
that parenteral
regulate the
For sickle cell
medication will
involved in
disease: zinc sulfate
be prepared and
immune
220 mg three times
administered by a
function.
daily.
health care
Functions as an
antioxidant by
being a cofactor
of the enzyme
super oxide
dismutase, which
is involved in the
removal of
harmful free
provider in a
To increase growth
and weight gain in
hospital setting.
children with sickle
Teach patient
cell disease who
proper
have not reached
administration
puberty: 10 mg
technique for eye
elemental zinc per
drops.
day.
radicals. Zinc is
also
For treating
attention deficit-
recommended by
hyperactivity
the World Health
disorder (ADHD) in
Organization
children: doses of
(WHO) and
zinc sulfate 55 mg
UNICEF as an
(15 mg elemental
adjunct in acute
zinc) to 150 mg (40
diarrhea
mg elemental zinc)
management
together with
daily.
reduced
For treating acne:
osmolarity oral
30-135 mg
rehydration salts
elemental zinc daily.
(ORS).
For treating agerelated macular
degeneration
(AMD): elemental
zinc 80 mg plus
vitamin C 500 mg,
vitamin E 400 IU,
and beta-carotene
15 mg daily.
B. IV INFUSION
CLASSIFICATION
INDICATION
CONTRAINDICATION
NURSING RESPONSIBILITIES
5 % dextrose and 0.3 NaCl
Fluid challenges,
Fluid replacement in
patient with DKA,
Hyponatremia, shock
• Don’t use with liver
disease, trauma, or
burns.
Use with caution
Hypotonic
•Water replacement
• DKA
• Gastric fluid loss from NG or vomiting
5% dextrose with multiple balance
solution
Isotonic
•Fluidloss
• Dehydration
• Hypernatremia
• May cause
cardiovascular collapse
or increased
intracranial pressure
For dehydration
For patient with
respiratory problems
ION multiple balance
All ions either positive
or negative are present
• Use cautiously in renal and
cardiac patients
• Can cause fluid overload
Do not use to patient without
case of dehydration