MS-Clinical Form 014
Lyceum of the Philippines University
College of Nursing
DRUG STUDY
Drug Name
Classification
and Mechanism
of Actions
Indication
Contraindication
Side
Effects/Adverse
Reaction
Nursing
Responsibilities
Monitoring Parameters
Brand Name:
Propylthiouracil
(PTU)
Classification:
Antithyroid agent
(Thionamide)
Hyperthyroidism
(Graves’ disease)
Hypersensitivity to
PTU or other
thionamides
Mechanism of
Action:
Inhibits thyroid
peroxidase enzyme
→ prevents
oxidation of iodide
and coupling of
iodotyrosines →
blocks synthesis of
thyroid hormones
(T3 & T4).
1. Verify
physician’s
order and correct
dose
before
administration.
2. Administer via NGT
for bedridden patient;
ensure tube patency
before giving.
3. Educate
patient/partner
to
report sore throat,
fever, or unusual
bleeding
(possible
agranulocytosis).
4. Monitor for signs of
hypothyroidism with
prolonged
use
(fatigue, weight gain,
constipation).
5. Provide
emotional
support to patient due
to
irritability
and
restlessness
from
thyroid storm.
6. Ensure medication is
given consistently at
the same time each
day for therapeutic
effect.
Vital Signs:
Monitor HR and BP (drug
should control tachycardia
and hypermetabolic state).
Generic Name:
Propylthiouracil
Common Side
Effects:
Nausea, vomiting,
rash, arthralgia,
pruritus, dizziness
Dosage: 50–150
mg every 8 hours
(dose
individualized
depending on
severity of thyroid
storm)
Frequency: Every 8
hours (q8h) or as
ordered by
physician
Route: Oral (via
NGT in bedridden
patient)
Also inhibits
peripheral
conversion of T4 to
the more active T3.
Thyroid storm
(impending or
acute crisis)
Pre-operative
management of
hyperthyroid
patients before
thyroidectomy
Alternative therapy
when radioactive
iodine or surgery is
not suitable
Pre-existing severe
liver disease
(hepatitis, cirrhosis) Serious Adverse
Reactions:
Pregnancy (use
● Agranulocytosis
with caution; PTU
(life-threatening
is preferred only
drop in WBC)
during 1st trimester
→ ↑ risk for
due to risk of
infection
hepatotoxicity)
● Hepatotoxicity
(liver failure,
Lactating mothers
jaundice)
(use cautiously,
● Severe skin
excreted in breast
reactions
milk)
(StevensJohnson
syndrome, toxic
epidermal
necrolysis)
● Vasculitis (rare)
Laboratory Tests:
• Thyroid function tests
(TSH, T3, T4)
• Liver function tests
(AST, ALT, bilirubin)
• CBC with differential
(monitor WBC for
agranulocytosis)
Clinical Monitoring:
• Improvement
of
restlessness,
irritability,
bulging
eyes,
and
other
hyperthyroid
symptoms.
• Monitor for adverse
effects: jaundice, sore
throat,
persistent
fever.
MS-Clinical Form 014
Drug Name
Brand Name:
Eliquis
Generic Name:
Apixaban
Dosage: 5 mg
Frequency: Twice
daily (BID), may be
adjusted to 2.5 mg
BID if elderly, renal
impairment, or low
body weight
Route: Oral (via
NGT for bedridden
patient)
Classification
and Mechanism
of Actions
Indication
Contraindication
Side
Effects/Adverse
Reaction
Classification:
Anticoagulant;
Direct Factor Xa
inhibitor
Stroke prevention
in non-valvular
atrial fibrillation
Active pathological
bleeding (e.g., GI
bleed, intracranial
hemorrhage)
Common Side
Effects:
Bruising, mild
nosebleeds, gum
bleeding, anemia,
nausea
Mechanism of
Action:
Selectively inhibits
Factor Xa,
preventing the
conversion of
prothrombin to
thrombin.
Decreases fibrin
clot formation,
platelet
aggregation, and
thrombus
development.
Treatment and
prevention of deep
vein thrombosis
(DVT) and
pulmonary
embolism (PE)
Post-operative
thromboprophylaxi
s after hip or knee
replacement
surgery
Secondary
prevention of
recurrent
thromboembolic
events
Severe
hypersensitivity to
apixaban
Patients with
prosthetic heart
valves
Severe hepatic
impairment (risk of
bleeding)
Caution in renal
impairment,
elderly, or those on
other
anticoagulants/anti
platelets
Serious Adverse
Reactions:
• Major bleeding
(intracranial,
gastrointestinal,
retroperitoneal
hemorrhage)
• Hypersensitivity
reactions (rash,
anaphylaxis –
rare)
• Thrombocytope
nia (rare)
Nursing
Responsibilities
Monitoring Parameters
1. Verify correct dose
and route; administer
via NGT for bedridden
patient.
2. Educate
patient/caregiver
about
bleeding
precautions:
avoid
sharp objects, contact
sports, and report
unusual
bruising/bleeding.
3. Do not discontinue
abruptly
without
physician order (↑ risk
of
stroke
or
thromboembolism).
4. Avoid
concomitant
use with NSAIDs or
aspirin
unless
prescribed (↑ bleeding
risk).
5. Reinforce medication
adherence, especially
in stroke prevention.
Vital Signs:
Monitor for hypotension,
tachycardia (may indicate
internal bleeding).
Clinical Monitoring:
Watch for signs of bleeding
–
hematuria,
melena,
hematemesis, gum/nose
bleeding, severe bruising.
Lab Monitoring:
• Routine
INR
monitoring is not
required
(unlike
warfarin).
• Renal
and
liver
function
tests
periodically.
Effectiveness:
Absence of new stroke
symptoms
(weakness,
slurred speech,
facial
droop)
or
DVT/PE
symptoms (leg swelling,
chest pain, dyspnea).
MS-Clinical Form 014
Drug Name
Classification
and Mechanism
of Actions
Indication
Contraindication
Side
Effects/Adverse
Reaction
Nursing
Responsibilities
Monitoring Parameters
Brand Name:
Chronulac,
Duphalac, Enulose
Classification:
Osmotic laxative;
Ammonia
detoxicant
Treatment of
constipation
(chronic or acute)
Patients on lowgalactose diet
(contains
galactose)
Common Side
Effects:
• Flatulence,
abdominal
cramping,
diarrhea,
belching
• Nausea,
dehydration if
excessive
stools occur
1. Administer with full
glass of water or via
NGT as ordered.
2. Assess
bowel
movement frequency,
consistency,
and
patient comfort.
3. Educate
patient/caregiver:
drug may take 24–48
hrs to produce effect.
4. Caution patient about
possible
abdominal
cramps and gas at the
start of therapy.
5. Encourage increased
fluid intake (if not
contraindicated)
to
prevent dehydration.
6. If used for hepatic
encephalopathy,
monitor
for
improvement
in
mental status.
Bowel Function: Monitor
stool consistency and
frequency (goal: 2–3 soft
stools/day).
Generic Name:
Lactulose
Dosage: 15–30 mL
orally/NGT daily
(dose adjusted until
2–3 soft stools/day)
Frequency: Once
or twice daily,
depending on
therapeutic
response
Route: Oral / via
NGT
/
Rectal
(enema if needed)
Mechanism of
Action:
Non-absorbable
disaccharide that is
metabolized in the
colon by bacteria
into lactic acid and
acetic acid.
These acids draw
water into the
bowel, softening
stools and
stimulating
peristalsis.
Lowers colonic pH,
converting
ammonia (NH₃) to
ammonium (NH₄⁺),
which reduces
serum ammonia
levels in patients
with hepatic
encephalopathy.
Management of
hepatic
encephalopathy
(reduces blood
ammonia levels)
Prevention of
straining in patients
who must avoid
increased
intracranial or intraabdominal
pressure
Bowel obstruction,
ileus, or perforation
Hypersensitivity to
lactulose or its
components
Use cautiously in
diabetics (contains
sugars)
Serious Adverse
Reactions:
• Severe
electrolyte
imbalance
(hyponatremia,
hypokalemia)
due to
prolonged
diarrhea
• Hypernatremia
(rare)
• Severe
dehydration
Hydration Status: Check
skin
turgor,
mucous
membranes,
intake &
output.
Electrolytes:
Monitor
sodium,
potassium,
bicarbonate
(risk
of
imbalance from diarrhea).
Therapeutic Response:
• Constipation: Relief
within 24–48 hrs.
• Hepatic
encephalopathy:
Decreased ammonia
levels,
improved
cognition, and less
confusion.
MS-Clinical Form 014
Drug Name
Classification
and Mechanism
of Actions
Indication
Contraindication
Brand Name:
Aldactone (may
vary by country)
Classification:
Potassium-sparing
diuretic;
aldosterone
antagonist
Treatment of
Edema associated
with congestive
heart failure, liver
cirrhosis, or
nephrotic
syndrome
Known
hypersensitivity to
spironolactone
Generic Name:
Spironolactone
Dosage: 25–100
mg/day (typical:
25–50 mg once
daily; may be
increased or
divided per
physician order)
Frequency: Once
daily or divided
(e.g., 25 mg PO qd
or 25 mg PO BID)
Route: Oral / via
NGT for bedridden
patient
Mechanism of
Action:
Competitively
inhibits aldosterone
receptors in the
distal renal tubules
→ decreases
sodium
reabsorption and
reduces potassium
and hydrogen ion
excretion.
Promotes diuresis
(sodium and water
excretion) while
conserving
potassium.
Management of
hyperaldosteronis
m (primary or
secondary)
Adjunct treatment
for refractory
hypertension
As add-on diuretic
therapy to reduce
potassium loss
when using loop or
thiazide diuretics
Side
Effects/Adverse
Reaction
Common Side
Effects:
• Hyperkalemia
(most clinically
Hyperkalemia
important)
(serum K⁺ >5.0–5.5 • Dizziness,
mmol/L depending
headache
on facility protocol)
• GI upset:
nausea,
Severe renal
vomiting,
impairment/anuria
diarrhea
(risk of life• Menstrual
threatening
irregularities,
hyperkalemia)
breast
tenderness
Addison’s disease
• Gynecomastia
(adrenal
in males
insufficiency)
Serious Adverse
Use with caution in Reactions:
pregnancy and
• Severe
lactation; discuss
hyperkalemia
with physician
→ muscle
weakness,
paresthesias,
life-threatening
cardiac
arrhythmias
• Acute kidney
injury (Severe
allergic reaction
(rare)
Nursing
Responsibilities
Monitoring Parameters
1. Confirm order (dose,
frequency, route); give
via NGT if unable to
take PO.
2. Check
serum
electrolytes
(K⁺),
BUN,
creatinine
before
&
during
therapy.
3. Monitor I&O, daily
weight, BP, HR; assist
with slow position
changes.
4. Review meds for
interactions (ACEIs,
ARBs,
K⁺
supplements,
NSAIDs,
K-sparing
agents, etc.).
5. Teach: avoid K⁺-rich
salt
substitutes/suppleme
nts unless ordered;
report
palpitations,
weakness, numbness,
↓ urine.
6. Watch
for
dehydration/hypotensi
on; notify MD if
present.
7. Document
drug,
response,
adverse
effects; withhold if K⁺
elevated above facility
threshold.
Electrolytes:
Serum
potassium and sodium —
baseline, within 48–72 hours
after initiation or dose
change, then periodically.
Renal
Function:
BUN,
creatinine — baseline and
periodically (more frequent if
renal impairment or on
interacting drugs).
Fluid Status: Daily weight,
I&O,
peripheral
edema
assessment.
Cardiovascular:
Blood
pressure
(including
orthostatic readings) and
heart rate monitoring.
Clinical Signs: Monitor for
muscle
weakness,
paresthesias,
arrhythmia
signs, dizziness, or signs of
gynecomastia/
endocrine
effects.
Drug
Interactions
/
Concomitant
Therapy:
Monitor
if
used
with
furosemide
(observe
potassium
trends),
ACE
inhibitors/ARBs
(increased
hyperkalemia risk).
MS-Clinical Form 014
Drug Name
Brand Name:
Hyalgan, Synvisc,
Euflexxa (varies by
brand)
Generic Name:
Sodium
Hyaluronate
Dosage: Typically
2 mL intra-articular
injection once
weekly for 3–5
weeks (depending
on brand/protocol)
Frequency: Weekly
(course depends
on physician order)
Route: Intraarticular (direct
injection into the
joint space)
Classification and
Mechanism of
Actions
Classification:
Viscosupplement;
Synovial fluid
replacement agent
Mechanism of
Action:
Sodium
hyaluronate is a
natural component
of synovial fluid
that provides
lubrication,
cushioning, and
shock absorption in
joints.
When injected into
an arthritic joint, it
restores synovial
fluid viscosity,
reduces pain,
improves mobility,
and may protect
cartilage from
further damage.
Indication
Contraindication
Side Effects/Adverse
Reaction
Nursing Responsibilities
Monitoring Parameters
Osteoarthritis of
the knee (for
patients who do not
respond
adequately to nonpharmacologic
therapy and
analgesics)
Known
hypersensitivity to
sodium
hyaluronate or
avian proteins
(some preparations
are derived from
rooster combs)
Infection or skin
disease at the
injection site
1. Verify order, drug,
dose, and site before
injection.
2. Use aseptic technique
to prevent infection.
3. Educate:
possible
pain/swelling
(≤48
hrs); avoid strenuous
activity/weightbearing for 48 hrs.
4. Check
for
avian
protein allergy (brandspecific).
5. Provide comfort (cold
compress if ordered).
6. Monitor
for
hypersensitivity/infecti
on;
report
immediately.
7. Document procedure,
tolerance,
adverse
effects.
Local reaction: swelling,
redness, or increased pain
at injection site
Joint pain relief
when NSAIDs are
contraindicated or
ineffective
Common Side
Effects:
• Pain, swelling,
warmth, or
redness at the
injection site
• Mild joint
stiffness or
discomfort
• Itching or rash
around the
injection area
Sometimes used
off-label in
ophthalmic
surgeries as a
viscoelastic agent
(to maintain
anterior chamber
depth, protect
corneal
endothelium, and
facilitate intraocular
procedures)
Septic arthritis or
active joint
infection
Severe
inflammation in the
affected joint
Serious Adverse
Reactions:
• Severe allergic
reaction/anaphy
laxis (rare)
• Joint infection
(septic arthritis)
• Pseudoseptic
reaction (acute
inflammation
mimicking
infection,
usually selflimiting)
Signs of infection: fever,
warmth, or persistent joint
pain/swelling
Pain level & mobility:
assess
therapeutic
response
over
the
treatment course
Allergic response: rash,
dyspnea, or other signs of
hypersensitivity
Functional improvement:
joint range of motion,
walking tolerance, and
reduced
need
for
analgesics
MS-Clinical Form 014
Drug Name
Brand Name:
Cellugel, Vidisic,
Liposic (varies by
brand)
Generic Name:
Carbomer
(Carbopol,
Polyacrylic acid
derivatives)
Dosage: 1 drop or
small amount of
gel/ointment as
prescribed
Frequency: Usually
3–4 times daily or
as needed
Route: Ophthalmic
(eye drops/gel) or
topical (skin use)
Classification and
Mechanism of
Actions
Classification:
Artificial tear
substitute;
Lubricant;
Demulcent
Mechanism of
Action:
Carbomer is a
synthetic highmolecular-weight
polymer that forms
a viscous gel.
In ophthalmic use,
it binds water and
increases tear film
stability, preventing
dryness and
irritation of the eye.
Provides moisture
and protection to
mucous
membranes or skin
by forming a
protective film.
Indication
Contraindication
Side Effects/Adverse
Reaction
Nursing Responsibilities
Monitoring Parameters
Ophthalmic Use:
Dry eye syndrome /
keratoconjunctivitis
sicca
Hypersensitivity to
carbomer or any
formulation
components
Common Side
Effects:
• Temporary
blurred vision
after application
• Mild burning,
stinging, or
sticky sensation
in the eyes
1. Verify correct drug,
dose, and indication
before administration.
2. Educate patient (or
caregiver):
Wash hands before &
after use.
Tilt head, pull lower
lid, apply gel; avoid
touching
applicator
tip.
Warn of temporary
blurred vision; avoid
walking
unassisted
after application.
3. Monitor
patient’s
comfort and ability to
blink
(especially
important in bedridden
or
neurologically
impaired patients).
4. Report persistent eye
irritation, swelling, or
signs of infection.
5. Document
administration, patient
tolerance, and any
side effects observed.
Ophthalmic
response:
reduction
of
dryness,
redness, or discomfort
Eye irritation
caused by reduced
blinking (common
in stroke patients
or bedridden
patients)
Topical Use:
As a gel base in
dermatologic
preparations (e.g.,
burn gels, wound
healing gels,
hydrating gels)
Patients with active
eye infections
unless prescribed
by ophthalmologist
Avoid prolonged
use without
medical
supervision (may
mask underlying
eye disease)
Serious Adverse
Reactions (rare):
• Allergic reaction
(redness,
swelling, itching
of eyes/eyelids)
• Eye pain,
worsening
dryness, or
visual
disturbances
Adverse reactions: eye
irritation, allergy, or visual
disturbances
Safety: risk of falls if patient
attempts to ambulate with
blurred
vision
after
application
In stroke patients: monitor
eye protection, as reduced
blinking or incomplete
eyelid closure increases
dryness risk
MS-Clinical Form 014
Drug Name
Brand: Humulin R,
Novolin R
Generic: Regular
insulin (shortacting)
Dosage:
IV (DKA/critical):
0.1 U/kg bolus →
0.1 U/kg/hr infusion
SC: Sliding scale
(1–10 U) or 0.05–
0.1 U/kg with feeds
Frequency: As
ordered — IV
continuous (hourly
titration) or SC
before meals/feeds
Route: IV infusion
or SC (never oral);
IV preferred if
unstable/NGT-fed
Classification and
Mechanism of
Actions
Classification:
Short-acting
insulin;
hypoglycemic
agent.
Mechanism of
Action:
Binds insulin
receptors →
facilitates cellular
uptake of glucose
(muscle, adipose)
and inhibits hepatic
gluconeogenesis
→ lowers blood
glucose.
Drives potassium
into cells,
potentially lowering
serum potassium.
Indication
Contraindication
Side Effects/Adverse
Reaction
Nursing Responsibilities
Monitoring Parameters
Hyperglycemia,
diabetes mellitus
(control of blood
glucose)
Hypersensitivity to
insulin or any
formulation
component
Common Side
Effects:
• Hypoglycemia
(sweating,
tremor,
tachycardia,
confusion,
diaphoresis)
• Injection site
reactions,
lipohypertrophy
or lipoatrophy
with repeated
SC injections
1. Verify order, insulin
type/dose/route
before giving.
2. Check CBG before
dose; hourly if IV
infusion.
3. For
NGT
feeds,
coordinate
timing;
hold
if
feeds
interrupted.
4. Never give insulin
orally; only IV or SC.
5. Use
aseptic
technique; rotate SC
sites.
6. Keep IV dextrose &
glucagon available.
7. Monitor
for
hypoglycemia; treat
promptly.
8. Monitor K⁺ with insulin
infusion; report low
levels.
9. Coordinate
with
nutrition team for
feed-insulin timing.
10. Teach caregiver about
hypoglycemia signs &
management (if for
home use).
Blood Glucose: Hourly if
IV; pre-feed/bedtime for
SC or per sliding scale.
Acute
hyperglycemic
crises (DKA, HHS)
requiring IV insulin
infusion
Hypoglycemia (do
not administer if
blood glucose is
low)
Perioperative or
inpatient glycemic
control in insulinrequiring patients
Use with extreme
caution in patients
with hypokalemia
(can worsen K⁺
deficit)
Correction of
elevated glucose
levels in NGT-fed
or critically ill
patients
Avoid IV
bolus/infusion
without appropriate
monitoring
capabilities
Serious Adverse
Reactions:
• Severe
hypoglycemia
→ seizures,
loss of
consciousness,
death if
untreated
• Hypokalemia
secondary to
insulin-driven
intracellular
shift of
potassium
• Allergic
reactions (rare)
Electrolytes:
Monitor
serum K⁺ baseline & with
infusion/dose changes.
VS & Neuro: Watch for
hypoglycemia
signs
(tachycardia, diaphoresis,
confusion, irritability).
I&O / Nutrition: Ensure
NGT feeds ongoing; hold
insulin if feeds stopped,
notify MD.
SC Sites: Check for
reaction/lipodystrophy.
Fluid
&
Acid-Base
(DKA/HHS): Monitor urine
output, electrolytes, acidbase status.
MS-Clinical Form 014
Drug Name
Brand Name:
Fluimucil,
Mucomyst,
Acetadote
Generic Name:
Acetylcysteine
Dosage: Varies
(e.g., 200–600 mg
PO every 8–12
hours; IV dosing
depends on
indication)
Frequency: Every
8–12 hours
(depending on
route/indication)
Route:
Inhalation,
Intravenous
Oral,
Classification
and Mechanism
of Actions
Indication
Contraindication
Side
Effects/Adverse
Reaction
Nursing
Responsibilities
Monitoring Parameters
Classification:
Mucolytic agent;
Antidote
Mucolytic therapy
for:
Chronic bronchitis,
COPD, pneumonia,
cystic fibrosis,
bronchiectasis
(thick mucus
conditions).
Hypersensitivity to
acetylcysteine.
Common Side
Effects:
• Nausea,
vomiting,
diarrhea,
abdominal pain
• Drowsiness,
fever,
unpleasant
odor/taste
• Rhinorrhea
(runny nose),
stomatitis
1. Verify
indication
(mucolytic
vs.
antidote).
2. For inhalation: Ensure
proper
nebulizer
setup, monitor for
bronchospasm,
provide bronchodilator
if needed.
3. For IV administration
(antidote):
Infuse
slowly to reduce risk of
anaphylactoid
reaction;
have
emergency equipment
ready.
4. Educate patient about
the foul odor/taste
(like rotten eggs) to
reduce
noncompliance.
5. Encourage adequate
hydration
to
aid
mucus clearance.
6. Provide suctioning if
patient
cannot
expectorate
effectively.
Respiratory status: Breath
sounds,
ease
of
expectoration,
oxygen
saturation.
Mechanism of
Action:
Breaks disulfide
bonds in
mucoproteins,
decreasing mucus
viscosity, making it
easier to
expectorate.
Restores
glutathione levels
in the liver,
protecting
hepatocytes from
acetaminophen
(paracetamol)
toxicity.
Antidote for
acetaminophen
(paracetamol)
overdose.
Adjunctive therapy
in contrast-induced
nephropathy (offlabel).
Caution in:
Patients with
history of
bronchospasm or
asthma (may
worsen airway
constriction).
Peptic ulcer
disease (can
irritate GI mucosa).
Serious Adverse
Reactions:
• Bronchospasm,
anaphylactoid
reactions
(especially IV
route)
• Hypotension,
tachycardia
• Severe allergic
reaction (rash,
urticaria,
angioedema)
Liver
function
tests:
Especially when given for
acetaminophen overdose
(AST, ALT, bilirubin).
Renal function: If used in
prevention of contrast
nephropathy.
Vital signs: HR, BP, RR
during IV infusion.
Signs
of
hypersensitivity/anaphylaxi
s: Rash, bronchospasm,
hypotension.
MS-Clinical Form 014
Drug Name
Classification
and Mechanism
of Actions
Indication
Contraindication
Side
Effects/Adverse
Reaction
Nursing
Responsibilities
Monitoring Parameters
Brand: Combivent
Respimat, Duolin
(varies)
Classification:
Salbutamol: SABA
(bronchodilator)
Ipratropium: Shortacting
anticholinergic
(bronchodilator)
Relief and
prevention of
bronchospasm in
asthma and COPD.
Hypersensitivity to
salbutamol,
ipratropium, or
formulation
components.
Common Side
Effects:
• Tremor,
nervousness,
headache
(salbutamol)
• Tachycardia,
palpitations
(salbutamol)
• Dry mouth,
cough, bitter
taste
(ipratropium)
• Mild dizziness
1. Verify
order
(dose,
frequency, route) and
choose delivery method
(neb
preferred
for
bedridden/NGT).
2. Assess
respiratory
status before/after (RR,
breath
sounds,
accessory
muscles,
SpO₂, cough, sputum).
3. Monitor VS (HR, BP)
before & 5–15 min after;
watch
for
tachycardia/arrhythmia.
4. Ensure
equipment
clean/functioning; use
sterile/clean saline if
nebulizer.
5. Position
upright
if
possible; provide O₂ if
ordered.
6. Watch
for
adverse
effects:
tremor,
palpitations, dry mouth,
urinary retention, visual
changes.
7. Teach
caregiver
inhaler/nebulizer use &
report severe dyspnea,
chest pain, palpitations.
8. Document
administration,
response, and side
effects.
Verify order (dose, frequency,
route) and choose delivery
method (neb preferred for
bedridden/NGT).
Generic:
Salbutamol +
Ipratropium
Dosage:
Nebulizer:
Salbutamol 2.5 mg
+ Ipratropium 0.5
mg
MDI: Salbutamol
100 mcg (2 puffs
PRN); Ipratropium
20 mcg (2 puffs
PRN) or combo
inhaler
Frequency: q4–6h
PRN or scheduled
(COPD/asthma)
Route: Inhalation
—
neb
(bedridden/NGT) or
MDI with spacer
Acute
exacerbations of
bronchospasm
(e.g., reactive
airway disease,
acute bronchitis).
Mechanism of
Action:
Salbutamol:
Stimulates β₂ →
Nebulized therapy
↑cAMP →
for patients who
bronchodilation
Ipratropium: Blocks cannot use inhalers
effectively (e.g.,
M3 receptors →
bedridden or
↓vagal
neurologically
bronchoconstriction
impaired patients).
& mucus
Combo: Synergistic
bronchodilation,
better airflow
Caution / relative
contraindication:
significant
tachyarrhythmias
or unstable cardiac
disease
(salbutamol can
increase heart
rate).
Use ipratropium
with caution in
patients with
narrow-angle
glaucoma, urinary
retention, or
prostatic
hypertrophy.
Avoid excessive
use (risk of
systemic β₂ or
anticholinergic
effects).
Serious Adverse
Reactions:
• Tachyarrhythmi
a, myocardial
ischemia
(higher risk in
cardiac
disease)
• Paradoxical
bronchospasm
(worsening
wheeze postinhalation)
• Acute narrowangle glaucoma
(if aerosol
contacts eyes)
• Urinary
retention
Assess respiratory status
before/after
(RR,
breath
sounds, accessory muscles,
SpO₂, cough, sputum).
Monitor VS (HR, BP) before &
5–15 min after; watch for
tachycardia/arrhythmia.
Ensure
equipment
clean/functioning;
use
sterile/clean
saline
if
nebulizer.
Position upright if possible;
provide O₂ if ordered.
Watch for adverse effects:
tremor,
palpitations,
dry
mouth, urinary retention,
visual changes.
Teach
caregiver
inhaler/nebulizer use & report
severe dyspnea, chest pain,
palpitations.
Document
administration,
response, and side effects.
MS-Clinical Form 014
Drug Name
Brand Name:
Xifaxan
Generic Name:
Rifaximin
Dosage: 400–550
mg
Frequency: Every
8–12 hours
(depending on
condition)
Route: Oral (via
mouth or NGT)
Classification and
Mechanism of
Actions
Classification:
Antibiotic
(Rifamycin
derivative, nonabsorbable GI
antibiotic)
Mechanism of
Action:
Rifaximin binds to
the β-subunit of
bacterial DNAdependent RNA
polymerase,
inhibiting bacterial
RNA synthesis. It
acts locally in the
gastrointestinal
tract with minimal
systemic
absorption,
reducing gut
bacteria that
produce toxins
(e.g., ammonia).
Indication
Contraindication
Side Effects/Adverse
Reaction
Nursing Responsibilities
Monitoring Parameters
Traveler’s diarrhea
(non-invasive E.
coli)
Hypersensitivity to
rifaximin,
rifamycins, or any
component of the
formulation
Common Side
Effects:
• Nausea
• Flatulence
• Abdominal pain
• Dizziness
• Headache
1. Administer via oral or
NGT as ordered,
ensure full dose is
delivered.
2. Educate patient/family
(if possible) about
purpose of medication
(to prevent/treat gutrelated infection or
encephalopathy).
3. Monitor patient for
allergic reactions or
intolerance.
4. Do not crush or mix
with
incompatible
substances
unless
directed.
5. Assess for diarrhea
severity
and
characteristics
(persistent/worsening
may indicate C. diff
infection).
6. Provide oral care and
hydration
support
(especially if on NGT).
GI
function
–
stool
frequency,
consistency,
and
presence
of
blood/mucus
Irritable bowel
syndrome with
diarrhea (IBS-D)
Hepatic
encephalopathy –
reduces recurrence
by decreasing
ammoniaproducing gut
bacteria
Used in
hospitalized
patients at risk of
infection or gutrelated
complications
Severe hepatic
impairment (ChildPugh C, unless
closely monitored)
Diarrhea with fever
and/or blood in
stool (may indicate
invasive bacteria)
Serious Adverse
Reactions:
• Hypersensitivity
reactions (rash,
angioedema,
anaphylaxis)
• Clostridioides
difficile–
associated
diarrhea (rare)
• Severe hepatic
impairment:
accumulation,
encephalopathy
worsening if not
properly
monitored
Neurological
status
–
monitor for changes in
mental status if being used
for hepatic encephalopathy
prevention
Liver function tests (LFTs)
in patients with hepatic
impairment
Signs of superinfection
(fever, worsening diarrhea,
thrush)
Allergic reactions (rash,
swelling,
difficulty
breathing)
MS-Clinical Form 014
Drug Name
Classification
and Mechanism
of Actions
Indication
Contraindication
Side
Effects/Adverse
Reaction
Nursing
Responsibilities
Monitoring Parameters
Brand Name:
Legalon, Siliphos,
Silymarin
(commercial
names vary)
Classification:
Hepatoprotective
herbal preparation;
antioxidant / liver
support agent.
Adjunctive therapy
for toxic or druginduced liver injury
(e.g., suspected
hepatotoxicity from
medications).
Known
hypersensitivity to
silymarin, milk
thistle, or
formulation
components.
Mechanism of
Action:
Contains
flavonolignans
(primarily silybin)
that stabilize
hepatocyte cell
membranes, inhibit
toxin binding and
entry, and promote
protein synthesis
and regeneration of
liver tissue.
Supportive therapy
in chronic liver
disease (e.g., nonalcoholic fatty liver
disease, hepatitis)
as adjunct per
physician.
Biliary tract
obstruction or
acute cholangitis
(use with caution;
may increase bile
flow).
1. Verify order & dose;
ensure formulation
safe
for
NGT
administration.
2. Check
baseline
LFTs (AST, ALT,
bilirubin, ALP) and
monitor
periodically.
3. Review meds for
interactions (esp.
anticoagulants,
CYP3A4/P-gp
substrates).
4. Educate caregiver:
silymarin
is
adjunctive, not a
replacement; report
rash, GI upset,
allergic reactions.
5. Monitor
clinical
response:
improvement
in
jaundice/abdominal
discomfort.
6. Ensure adherence;
avoid
duplicate
herbal
supplements.
7. Notify MD if LFTs
worsen,
cholestasis signs,
or bleeding occurs.
Laboratory: AST, ALT,
total & direct bilirubin, ALP
— baseline and periodic
checks (frequency per
physician).
Generic Name:
Silymarin (extract
of Silybum
marianum — milk
thistle)
Common Side
Effects:
• Gastrointestinal
upset (nausea,
diarrhea,
abdominal
discomfort)
• Mild headache
• Allergic skin
reactions (rash)
in sensitive
individuals
Dosage: 140 mg
per dose
commonly; typical
total daily dose
140–420 mg/day
(e.g., 140 mg PO
TID) — follow
physician order.
Frequency: Usually
TID or as
prescribed.
Route: Oral (can be
given via NGT if
prescribed
and
formulation allows).
Exerts antioxidant
effects by
scavenging free
radicals and
enhancing
glutathione levels,
reducing oxidative
hepatic injury.
Hepatoprotective
support during
therapy with
potentially
hepatotoxic agents
(monitoring
required).
Serious Adverse
Use with caution in Reactions (rare):
pregnancy/lactation • Severe
—only if benefit
hypersensitivity/
outweighs risk and
anaphylaxis
prescribed by
(rare)
physician.
• Possible drug
interactions
leading to
altered levels of
concomitant
medications
(see nursing
responsibilities)
Coagulation:
INR
/
bleeding
signs
if
concurrent anticoagulant
therapy (e.g., apixaban) —
monitor closely for any
bleeding tendency.
Clinical:
Jaundice,
abdominal pain, pruritus,
changes in mental status (if
hepatic
encephalopathy
risk), appetite.
Adverse
effects:
GI
symptoms,
rash,
hypersensitivity signs.
Drug interactions: Observe
for unexpected changes in
effect or adverse events
from concomitant drugs
metabolized
via
CYP3A4/P-gp;
communicate
abnormalities
to
prescriber.
MS-Clinical Form 014
Drug Name
Brand Name: Lasix
Generic Name:
Furosemide
Classification and
Mechanism of
Actions
Classification: Loop
diuretic;
antihypertensive;
natriuretic agent
Dosage: Varies
depending on
condition
(commonly 20–80
mg/day, may be
increased as
prescribed; IV or
PO dosing per
doctor’s order)
Mechanism of
Action:
Inhibits
reabsorption of
sodium, potassium,
and chloride in the
ascending loop of
Henle and distal
renal tubule.
Frequency: Once
daily or in divided
doses; IV dosing
may be every 6–12
hours as ordered
Promotes excretion
of water, sodium,
chloride,
magnesium,
potassium, and
calcium.
Route: Oral (PO),
Intravenous (IV),
Intramuscular (IM)
Reduces plasma
volume →
decreases blood
pressure, reduces
preload/afterload,
and relieves
edema.
Indication
Contraindication
Side Effects/Adverse
Reaction
Nursing Responsibilities
Monitoring Parameters
Edema associated
with:
Congestive Heart
Failure (CHF)
Liver cirrhosis
Renal disease
(including nephrotic
syndrome)
Hypersensitivity to
furosemide or
sulfonamides
Common Side
Effects:
• Dizziness,
headache,
blurred vision
• Hypotension
• Dehydration,
polyuria
• Electrolyte
imbalances
(hypokalemia,
hyponatremia,
hypocalcemia,
hypomagnesem
ia)
1. Check baseline: BP,
HR, weight, urine
output.
2. Monitor: electrolytes
(K⁺, Na⁺, Cl⁻, Mg²⁺)
and renal function
(BUN, creatinine).
3. Administer IV slowly
(20–40 mg/min) to
avoid ototoxicity.
4. Educate:
increased
urination, potassiumrich
foods,
dehydration signs.
5. Implement
fall
precautions
for
dizziness/hypotension
.
6. Monitor
hearing
during IV therapy.
7. Track I&O to assess
effectiveness.
Vital signs: BP, HR before
and after administration
(risk for hypotension).
Hypertension
(alone or with other
antihypertensives)
Acute pulmonary
edema
Hypercalcemia
(with IV saline)
Anuria (no urine
output)
Severe electrolyte
depletion (e.g.,
hypokalemia,
hyponatremia,
hypovolemia)
Hepatic coma /
severe liver
disease without
medical
supervision
Use with caution in
renal impairment,
diabetes mellitus,
gout, pregnancy,
and breastfeeding
Serious Adverse
Reactions:
• Ototoxicity
(hearing loss,
tinnitus,
especially with
rapid IV push)
• Severe
hypokalemia →
arrhythmias
• Stevens–
Johnson
Syndrome
(rare)
• Agranulocytosis
, aplastic
anemia (rare
but serious)
Weight: Daily weight to
assess fluid balance.
Intake and Output (I&O):
Strict monitoring.
Laboratory values:
Serum electrolytes: K⁺,
Na⁺, Mg²⁺, Ca²⁺
Renal
function:
BUN,
Creatinine
Hearing
function:
Especially with IV therapy
(risk for ototoxicity).
Edema status: Peripheral
edema,
lung
sounds,
ascites.
MS-Clinical Form 014
Drug Name
Brand Name:
Losec, Prilosec
Generic Name:
Omeprazole
Dosage: Common
adult dose: 20–40
mg/day
Frequency: Once
daily (may be twice
daily for severe
cases)
Route: Oral (PO),
Intravenous (IV)
Classification and
Mechanism of
Actions
Classification:
Proton Pump
Inhibitor (PPI);
Anti-ulcer agent
Mechanism of
Action:
Irreversibly inhibits
the
hydrogen/potassiu
m ATPase enzyme
system (“proton
pump”) of gastric
parietal cells.
Blocks the final
step of gastric acid
production →
reduces gastric
acidity.
Provides 24-hour
inhibition of both
basal and
stimulated gastric
acid secretion.
Indication
Contraindication
Side Effects/Adverse
Reaction
Nursing Responsibilities
Monitoring Parameters
Gastroesophageal
reflux disease
(GERD)
Hypersensitivity to
omeprazole or
other PPIs
Caution in:
Severe hepatic
impairment
Long-term use (risk
of B12 deficiency,
hypomagnesemia,
bone fractures)
Pregnancy/lactatio
n (use only if
clearly needed)
1. Administer
before
meals, preferably in
the morning.
2. Do not crush or chew
delayed-release
capsules/tablets;
swallow whole.
3. If
given
IV,
reconstitute
and
infuse
as
per
guidelines (not as
rapid IV push).
4. Assess for abdominal
pain, GI bleeding
(hematemesis,
melena) before and
during therapy.
5. Educate patient:
Avoid
alcohol,
NSAIDs, and smoking
(these worsen gastric
irritation).
Report
persistent
diarrhea, abdominal
pain, or signs of
hypomagnesemia
(tremors,
palpitations).
Long-term
therapy
may need monitoring
for bone health and
vitamin
B12
supplementation.
GI symptoms: relief of
heartburn, epigastric pain,
reflux.
Peptic ulcers
(gastric and
duodenal)
Common Side
Effects:
• Headache,
dizziness
• Abdominal pain,
nausea,
constipation,
diarrhea,
flatulence
• Rash, pruritus
Erosive esophagitis
Zollinger–Ellison
syndrome (gastric
acid
hypersecretion)
Prophylaxis of
stress ulcers in
critically ill patients
Adjunct therapy in
H. pylori
eradication (with
antibiotics)
Serious Adverse
Reactions:
• Clostridium
difficile–
associated
diarrhea
• Vitamin B12
deficiency
(long-term use)
• Hypomagnese
mia (muscle
cramps,
arrhythmias,
seizures)
• Osteoporosisrelated bone
fractures (with
prolonged
therapy)
• Acute interstitial
nephritis (rare
but serious)
Stool/Emesis: check for
blood (GI bleeding).
Laboratory tests:
Liver function (ALT, AST)
in long-term use.
Serum
magnesium,
calcium, and vitamin B12
for prolonged therapy.
Adverse effects: diarrhea,
rash, or allergic reactions.
Bone health: monitor in
patients on long-term or
high-dose therapy
MS-Clinical Form 014
Drug Name
Brand Name:
Myra-E, Aquasol E,
E-Vit
Generic Name:
Vitamin E
(Tocopherol /
Tocopheryl
acetate)
Dosage:
Usual adult: 200–
400 IU/day (varies
based on
deficiency or
therapeutic use)
Frequency: Once
daily (may vary
depending on
deficiency
treatment)
Route: Oral (PO),
Injectable (IM,
rarely used if
severe deficiency)
Classification and
Mechanism of
Actions
Classification: Fatsoluble vitamin,
Antioxidant
Mechanism of
Action:
Acts as a biological
antioxidant,
protecting cell
membranes from
oxidative damage
by free radicals.
Helps maintain
integrity of red
blood cells, skeletal
muscle, and
neurological
function.
May improve
circulation and
prevent clot
formation by
inhibiting platelet
aggregation.
Indication
Contraindication
Side Effects/Adverse
Reaction
Nursing Responsibilities
Monitoring Parameters
Vitamin E
deficiency (rare;
usually due to fat
malabsorption
syndromes like
cystic fibrosis,
chronic
pancreatitis, biliary
atresia).
Hypersensitivity to
vitamin E
Common Side
Effects:
• Mild GI upset
(nausea,
diarrhea,
abdominal
cramps)
• Fatigue,
headache,
blurred vision
(with high
doses)
1. Verify correct dosage
and route (especially if
given via NGT, ensure
complete flushing to
avoid clogging).
2. Educate
patient/family:
Best absorbed with
meals
containing
dietary fats.
Avoid high doses
unless prescribed—
risk of bleeding.
Inform
healthcare
provider if patient is
taking anticoagulants.
3. Monitor for signs of
bleeding
(bruising,
gum
bleeding,
hematuria, melena).
4. Evaluate neurological
status and muscle
strength (especially
important for stroke
patients).
Neurological
function:
monitor improvement or
worsening
of
stroke
symptoms.
Adjunct in
cardiovascular
diseases (to
reduce oxidative
stress and prevent
clot formation).
Neurological
disorders related to
oxidative damage.
Adjunct in acute
cerebrovascular
disease: used for
its antioxidant
properties to help
protect neural
tissue from further
damage.
High doses
contraindicated in:
Patients with
bleeding disorders
(e.g., hemophilia)
Vitamin K
deficiency
Patients on
anticoagulant/antipl
atelet therapy
(warfarin, aspirin,
clopidogrel) due to
increased bleeding
risk
Serious Adverse
Reactions:
• Increased risk
of
bleeding/hemor
rhagic stroke
with high doses
• Muscle
weakness,
fatigue (longterm high dose
use)
• Toxicity (rare):
hepatomegaly,
thrombophlebiti
s
Signs of bleeding: gums,
stool, urine, injection sites.
Liver function tests (LFTs)
if
on
long-term
supplementation.
Serum lipid profile (in
cardiovascular patients).
Serum vitamin E levels if
available
(to
assess
deficiency or toxicity).
MS-Clinical Form 014
Drug Name
Brand Name:
Inderal,
Hemangeol (brand
names vary)
Generic Name:
Propranolol
Dosage:
PO
(hyperthyroidism/th
yroid storm): 20–80
mg per dose;
typical start 40 mg
every 6–8 hrs
(individualized).
IV bolus (rapid
control): 1–3 mg
IV, repeat PRN per
protocol (monitored
setting).
Classification and
Mechanism of
Actions
Classification: Nonselective βadrenergic blocker
(beta-blocker)
Mechanism of
Action:
Competitively
blocks β₁ and β₂
adrenergic
receptors,
decreasing heart
rate, myocardial
contractility, and
cardiac output.
In
hyperthyroidism/thy
roid storm, reduces
symptoms by
controlling
tachycardia and
Frequency: PO q6– inhibiting peripheral
8h or per order; IV
conversion of T4 →
per protocol.
T3 (partial effect).
Route: Oral (PO,
NGT if allowed) or
IV for acute control
Indication
Contraindication
Side Effects/Adverse
Reaction
Nursing Responsibilities
Monitoring Parameters
Control of
tachycardia,
tremor, and
sympathetic
symptoms in
hyperthyroidism/thy
roid storm.
Absolute/Relative:
Severe
bradycardia, 2nd–
3rd degree heart
block without
pacemaker.
Cardiogenic shock
or uncontrolled
congestive heart
failure (acute
decompensated
HF).
Severe reactive
airway disease
(active asthma) —
nonselective βblocker may
precipitate
bronchospasm.
Severe peripheral
arterial disease
(caution).
Common Side
Effects:
• Bradycardia,
fatigue,
dizziness, sleep
disturbances,
cold
extremities.
• Gastrointestinal
upset.
1. Verify order: correct
dose,
route,
indication;
confirm
NGT use if needed.
2. Check baseline: HR,
BP, RR, SpO₂, ECG;
hold if HR <60,
systolic BP low, or
heart block.
3. Monitor: HR & BP 30–
60 min after PO
(earlier
if
IV),
respiratory
status,
cerebral
perfusion,
and blood glucose in
diabetics.
4. Educate
caregiver:
hypoglycemia signs
may
be
masked;
report
dizziness,
wheezing, fainting, or
breathing difficulty.
5. Do not stop abruptly:
taper per plan.
6. Document:
administration,
response,
adverse
effects;
report
significant changes.
VS: HR & BP before and
after
dose;
document
trends.
Rate control in
supraventricular
tachyarrhythmias
(AF, atrial flutter).
Hypertension,
angina pectoris,
prophylaxis of
migraine, essential
tremor, and others
per physician
order.
Use caution with
diabetes mellitus
(masks
hypoglycemia
signs), and in
patients on other
negative
chronotropes
(CCBs, digoxin).
Serious Adverse
Reactions:
• Severe
bradycardia,
hypotension,
heart block,
worsening heart
failure.
• Bronchospasm
in susceptible
patients
(wheezing,
dyspnea).
• Masking of
hypoglycemia
symptoms
(tachycardia,
tremor).
• CNS effects:
depression,
hallucinations
(rare).
Cardiac monitoring: ECG if
arrhythmia present or
IV/large dose.
Respiratory:
Breath
sounds, wheeze, SpO₂
(esp. COPD/asthma).
Blood glucose: Monitor in
diabetics or if symptomatic.
Perfusion signs: Mental
status,
urine
output,
dizziness;
avoid
hypotension in stroke.
Drug interactions: Review
meds (CCBs, digoxin,
antiarrhythmics, insulin) for
bradycardia, AV block, or
masked hypoglycemia.
MS-Clinical Form 014
Drug Name
Brand Name:
Cortef, SoluCortef
Generic Name:
Hydrocortisone
Dosage: Varies
(Typical: 100 mg
IV bolus initially,
then 100 mg IV
every 6–8 hrs in
acute cases like
thyroid
storm/adrenal
crisis;
maintenance
doses differ)
Frequency:
Depends on
indication (acute
use: q6–8h;
maintenance:
once daily oral)
Route: IV, IM,
oral, topical
Classification and
Mechanism of
Actions
Classification:
Glucocorticoid
(Corticosteroid);
Anti-inflammatory;
Immunosuppressant
Mechanism of
Action:
Hydrocortisone
mimics cortisol, a
natural
glucocorticoid
hormone, exerting
effects by binding to
intracellular
glucocorticoid
receptors. It reduces
inflammation by
inhibiting leukocyte
migration,
suppressing
prostaglandin/cytoki
ne production, and
decreasing capillary
permeability. It also
helps restore blood
pressure and
metabolism in
adrenal
insufficiency/thyroid
storm.
Indication
Contraindication
Side Effects/Adverse
Reaction
Nursing Responsibilities
Monitoring Parameters
Adrenal
insufficiency
(Addison’s disease,
adrenal crisis)
Systemic fungal
infections
Common Side Effects:
• GI upset
(nausea,
vomiting,
stomach pain)
• Increased
appetite, weight
gain
• Mood changes
• Fluid retention,
edema,
increased blood
pressure
• Hyperglycemia
Serious Adverse
Reactions:
• Adrenal
suppression
(long-term use)
• Increased risk of
infection
• Peptic ulcers/GI
bleeding
• Osteoporosis
with chronic use
• Myopathy/weakn
ess
• Cushingoid
features (moon
face, buffalo
hump, truncal
obesity)
• Psychosis,
seizures (rare but
possible in highdose IV use)
1. Administer
hydrocortisone
exactly as prescribed
(IV push slowly or
infusion if IV route).
2. Assess patient for
signs of improvement
in inflammation, BP
stabilization,
and
decreased
thyroid
storm manifestations
(fever,
tachycardia,
agitation).
3. Monitor for signs of
infection
(drug
suppresses immune
response).
4. Educate patient/family
about not stopping the
drug abruptly to avoid
adrenal crisis.
5. Provide GI protection
(e.g.,
PPIs
like
omeprazole)
since
corticosteroids ↑ ulcer
risk.
6. Ensure proper dosage
tapering if given longterm.
7. Advise patient about
possible
mood/behavioral
changes and to report
severe mood swings.
Vital signs:
temperature
masking,
monitoring)
Severe allergic
reactions/anaphyla
xis
Inflammatory and
autoimmune
conditions (e.g.,
rheumatoid
arthritis, lupus,
severe asthma,
inflammatory bowel
disease)
Shock or severe
infections (with
sepsis, adrenal
support)
Cerebral edema
(secondary to
tumor or trauma)
Thyroid storm (as
part of
management to
reduce peripheral
conversion of T4 to
T3)
Untreated serious
bacterial/viral
infections (unless
life-threatening
emergency)
Known
hypersensitivity to
hydrocortisone or
other
corticosteroids
Use with caution in
patients with:
peptic ulcer
disease,
uncontrolled
diabetes,
hypertension,
osteoporosis,
psychiatric
disorders, or
immunosuppressio
n
BP, HR,
(infection
shock
Blood glucose levels: risk
of hyperglycemia
Electrolytes:
sodium,
potassium (risk of fluid
retention/hypokalemia)
Signs of infection: fever,
sore throat, delayed wound
healing
GI symptoms: abdominal
pain, black tarry stools (GI
bleeding)
Neurological
status:
confusion,
restlessness
(esp. relevant in stroke +
thyroid storm patient)
Weight and fluid balance:
monitor edema, I&O
Signs
of
adrenal
suppression if withdrawn
suddenly
MS-Clinical Form 014
Drug Name
Brand Name:
Zosyn (common
brand; may vary by
country)
Generic Name:
Piperacillin /
Tazobactam
Dosage: Typical
adult dosing: 3.375
g IV every 6 hours
or 4.5 g IV every
6–8 hours (dose
adjusted for
severity and renal
function).
Frequency: q6h (or
q6–8h) per
physician order
and renal function.
Route: Intravenous
(IV) infusion —
usually infused
over 30 minutes
(follow facility
protocol).
Classification and
Mechanism of
Actions
Classification:
Broad-spectrum βlactam antibiotic
(extendedspectrum penicillin)
combined with βlactamase inhibitor.
Mechanism of
Action:
Piperacillin: Inhibits
bacterial cell wall
synthesis by
binding penicillinbinding proteins →
bactericidal.
Tazobactam: βlactamase inhibitor
that protects
piperacillin from
enzymatic
degradation by βlactamase–
producing
organisms →
extends spectrum
against resistant
bacteria.
Indication
Contraindication
Moderate to severe
infections caused
by susceptible
organisms,
including:
Known
hypersensitivity to
penicillins,
cephalosporins, or
other β-lactam
antibiotics.
Side Effects/Adverse
Reaction
Common Side
Effects:
• Diarrhea,
nausea,
vomiting
• Injection site
Hospital-acquired
pain, phlebitis
pneumonia or
Caution/relative
with IV infusion
aspiration
contraindication in
• Rash
pneumonia
severe renal
Serious Adverse
(common in
impairment — dose Reactions:
NGT/bedridden
adjustment
• Hypersensitivity
patients).
required.
reactions
(urticaria,
Intra-abdominal
Caution in patients
anaphylaxis)
infections,
with history of
• Clostridioides
complicated urinary
severe allergic
difficile–
tract infections,
reactions
associated
skin/soft tissue
(anaphylaxis) to βdiarrhea /
infections,
lactams.
pseudomembra
septicemia.
nous colitis
• Bone marrow
Empiric broad
effects
coverage for
(neutropenia,
nosocomial
thrombocytopen
infections pending
ia) with
culture results.
prolonged use
• Seizures in
patients with
high doses or
severe renal
impairment
• Hepatic enzyme
elevation (rare)
Nursing Responsibilities
Monitoring Parameters
1. Verify
allergies
(penicillin/cephalosporin
); document reaction.
2. Confirm dose & renal
adjustment
(check
creatinine/eGFR).
3. Administer
IV
per
protocol; infuse over
recommended time (≈30
min).
4. Obtain cultures before
first dose when possible.
5. Monitor IV site for
infiltration/phlebitis;
rotate as needed.
6. Watch
for
allergic
reactions:
rash,
bronchospasm,
hypotension.
7. Monitor for diarrhea/C.
difficile.
8. Check IV compatibility
with other meds/fluids.
9. Document
administration,
response,
adverse
effects.
10. Monitor bleeding in
patients
on
anticoagulants; report
changes.
11. Communicate
culture/sensitivity results
for possible therapy
adjustment.
Clinical:
Temp,
HR,
respiratory
status,
wound/sputum
improvement.
Labs:
CBC
(monitor
leukopenia/thrombocytope
nia),
renal
function
(BUN/creatinine), LFTs if
indicated.
Stool: Monitor for blood;
evaluate for C. difficile if
diarrhea.
IV site: Check for redness,
swelling, infusion pain.
Neuro: Monitor mental
status, seizure risk (esp.
renal
impairment/high
dose).
Bleeding:
Inspect
hematoma/other
sites;
check H&H if bleeding
suspected, especially with
anticoagulants.
MS-Clinical Form 014