NCM 106 SY 2020-2021

DRUG STUDY
 NCM 106 SY 2020-2021

DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE NURSING RESPONSIBILITIES

OF ACTION EFFECT
Synthetic UTIs, lower UTIs, lower respiratory GI: Nausea, Assessment & Drug Effects
GENERIC NAME quinolone that is a respiratory tract tract infections, skin and vomiting, diarrhea,
CIPROFLOXACIN broad spectrum infections, skin skin structure infections, cramps, gas,  Report tendon inflammation or
HYDROCHLORIDE bactericidal agent. and skin structure bone and joint infections, pseudomembranous pain. Drug should be discontinued.
CIPROFLOXACIN Inhibits DNA- infections, bone GI infection or infectious colitis.   Lab tests: Culture and sensitivity
OPHTHALMIC gyrase, an enzyme and joint diarrhea, chronic bacterial tests should be done prior to initial
necessary for infections, GI prostatitis, nosocomial Metabolic: Transient dose. Treatment may be
bacterial DNA infection or pneumonia, acute sinusitis. increases in liver implemented pending results.
BRAND NAME replication and infectious Post-exposure prophylaxis transaminases,  Monitor urine pH; it should be less
Cipro, Cipro some aspects of diarrhea, chronic for alkaline than 6.8, especially in the older
IV, Cipro XR, transcription, bacterial anthrax. Ophthalmic: Cor phosphatase, lactic adult and patients receiving high
Proquin XR repair, prostatitis, neal ulcers, bacterial dehydrogenase, and dosages of ciprofloxacin, to reduce
Ciloxan recombination, nosocomial conjunctivitis caused eosinophilia count.  the risk of crystalluria.
and transposition. pneumonia, acute by Staphylococci,  Monitor I&O ratio and patterns:
CLASSIFICATION sinusitis. Post- Streptococci, and Pseudo Musculoskeletal: Te Patients should be well hydrated;
ANTIINFECTIVE;  exposure monas aeruginosa. ndon rupture, assess for S&S of crystalluria.
QUINOLONE prophylaxis for cartilage erosion.   Monitor plasma theophylline
ANTIBIOTIC anthrax. Ophthal concentrations, since drug may
mic: Corneal Cautious Use CNS: Headache, interfere with half-life.
DOSAGE ulcers, bacterial vertigo, malaise,  Administration with theophylline
Uncomplicated UTI conjunctivitis Known or suspected CNS peripheral derivatives or caffeine can cause
Adult: PO 250 mg caused disorders (i.e., severe neuropathy, seizures CNS stimulation.
q12h or 500 mg XR by Staphylococci, cerebral arteriosclerosis or (especially with  Assess for S&S of GI irritation
q.d. x 3 d IV 200 mg Streptococci, and  seizure disorders); rapid IV infusion).  (e.g., nausea, diarrhea, vomiting,
q12h, infused over 60 Pseudomonas myasthenia gravis; abdominal discomfort) in clients
min aeruginosa. myocardial ischemia, atrial Skin: Rash, receiving high dosages and in older
fibrillation, QT elongation, phlebitis, pain, adults.
Complicated UTI CHF; GI disease, colitis; burning, pruritus,  Monitor PT and INR in patients
Adult: PO 1000 mg CVA; uncorrected and erythema at receiving coumarin therapy.
 NCM 106 SY 2020-2021

XR q.d. x 7–14 infusion site.   Assess for S&S of superinfections

d IV 400 mg q12h, hypokalemia; patients (see Appendix F).
infused over 60 min receiving theophylline Special
derivatives or caffeine, Senses: Local Patient & Family Education
Acute Sinusitis severe renal impairment burning and
Adult: PO 500 mg and crystalluria during discomfort,  Immediately report tendon
b.i.d. x 10 d ciprofloxacin therapy, and crystalline inflammation or pain. Drug should
patients on coumarin precipitate on be discontinued.
Moderate to Severe therapy; children. superficial portion of  Fluid intake of 2–3 L/d is advised,
Systemic Infection cornea, lid margin if not contraindicated.
Adult: PO 500–750 crusting, scales,  Report sudden, unexplained joint
mg q12h IV 200–400 foreign body pain.
mg q12h, infused sensation, itching,  Restrict caffeine due to the
over 60 min and conjunctival following effects (e.g.,
hyperemia. nervousness, insomnia, anxiety,
Renal Impairment tachycardia).
Clcr 30–50  Report possible toxicity. If taking
mL/min: PO 250–500 theophylline derivatives, there is
mg q12h, IV no potential for adverse effects.
change in dose; <30  Report nausea, diarrhea, vomiting,
mL/min: PO 250–500 and abdominal pain or discomfort.
mg q18h, IV 200–400  Use caution with hazardous
mg q18–24h activities until reaction to drug is
known. Drug may cause light-
Bacterial headedness.
Conjunctivitis  Do not breast feed while taking this
Adult: Ophthalmic 1– drug.
2 drops in
conjunctival sac q2h
while awake for 2 d,
then 1–2 drops q4h
 NCM 106 SY 2020-2021

while awake for the

next 5 d Ointment ½-
inch ribbon into
conjunctival sac t.i.d.
times 2 d, then b.i.d.
times 5 d

Corneal Ulcers
Adult: Ophthalmic 2
drops q15min for 6 h,
2 drops q30min for
the next 18 h, then 2
drops q1h for 24 h,
then 2 drops q4h for
14 d
 NCM 106 SY 2020-2021

DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE NURSING RESPONSIBILITIES

OF ACTION EFFECT
Antibacterial Treatment of Hypersensitivity to CNS: Headache, Assessment & Drug Effects
GENERIC NAME combination moderate to severe piperacillin, tazobactam, insomnia,
PIPERACILLIN/ product consisting appendicitis, penicillins, fever. GI: Diarrhea,  Obtain history of hypersensitivity
TAZOBACTAM of the uncomplicated and cephalosporins, or beta- constipation, nausea, to penicillins, cephalosporins, or
semisynthetic complicated skin lactamase inhibitors such vomiting, other drugs prior to administration.
BRAND NAME piperacillin and and skin structure as clavulanic acid and dyspepsia, pseudome  Lab tests: C&S prior to first dose of
Zosyn the beta-lactamase infections, sulbactam. mbranous the drug; start drug pending results.
inhibitor endometritis, colitis. Skin: Rash, Monitor hematologic status with
CLASSIFICATION tazobactam. pelvic Cautious Use pruritus, prolonged therapy (Hct and Hgb,
ANTIINFECTIVE;  Tazobactam inflammatory hypersensitivity CBC with differential and platelet
BETA-LACTAM component does disease, or Kidney failure; pregnancy reactions. count).
ANTIBIOTIC; ANTI not decrease the nosocomial or (category B), lactation.  Monitor patient carefully during the
PSEUDOMONAL activity of the community- first 30 min after initiation of the
PENICILLIN piperacillin acquired infusion for signs of
component against pneumonia caused hypersensitivity (see Appendix F).
DOSAGE susceptible by piperacillin-
Moderate to Severe organisms. resistant, Patient & Family Education
Infections piperacillin/tazoba
Adult: IV 3.375 g Tazobactam is an ctam-susceptible,  Report rash, itching, or other signs
q6h, infused over 30 inhibitor of a wide beta-lactamase- of hypersensitivity immediately.
min, for 7–10 d variety of bacterial producing  Report loose stools or diarrhea as
Child: IV <6 beta–lactamases. It bacteria. these may indicate
mo, 150–300 mg has little pseudomembranous colitis.
piperacillin/kg/d antibacterial  Do not breast feed while taking this
divided q6–8h;  6 activity itself; drug without consulting physician.
mo, 240 mg however, in
piperacillin combination with
component/kg/d piperacillin, it
divided q8h extends the
 NCM 106 SY 2020-2021

spectrum of
Nosocomial bacteria that are
Pneumonia susceptible to
Adult: IV 4.5 g q6h, piperacillin. Two-
infused over 30 min, drug combination
for 7–10 d has antibiotic
activity against an
Renal Insufficiency extremely broad
Clcr 20–40 mL/min: spectrum of gram-
2.25 g q6h; <20 positive, gram-
mL/min: 2.25 g q8h negative, and
anaerobic bacteria.
 NCM 106 SY 2020-2021

DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE NURSING RESPONSIBILITIES

OF ACTION EFFECT
Semisynthetic Infections caused Hypersensitivity to Body as a Assessment & Drug Effects
GENERIC NAME beta-lactam by susceptible cephalosporins and related Whole: Fever, chills,
CEFOTETAN antibiotic, organisms in beta-lactam antibiotics; injection site pain,  Determine history of
DISODIUM classified as a urinary tract, pregnancy (category B). inflammation, hypersensitivity to cephalosporins
third-generation lower respiratory disulfiram-like and penicillins, and other drug
BRAND NAME cephalosporin. tract, skin and skin Cautious Use reaction. allergies, before therapy begins.
Cefotan Preferentially structures, bones  Lab tests: Perform culture and
binds to one or and joints, Lactation. GI: Nausea, sensitivity studies before initiation
CLASSIFICATION more of the gynecologic tract; vomiting, diarrhea, a of therapy and during therapy, as
ANTIINFECTIVE;  penicillin-binding also intra- bdominal pain, indicated. Therapy may begin
ANTIBIOTIC;  proteins (PBP) abdominal antibiotic-associated pending test results. Perform
THIRD- located on cell infections, colitis.  periodic hematologic studies
GENERATION walls of bacteremia, and (including PT/INR and PTT) and
CEPHALOSPORIN susceptible perioperative Hematologic: Throm evaluation of renal function,
organisms. This prophylaxis. bocytopenia, especially if cefotetan dose is high
DOSAGE inhibits third and prolongation of or if therapy is prolonged in order
Moderate to Severe final stage of bleeding time or to recognize symptoms of
Infections bacterial cell wall prothrombin time.  nephrotoxicity and ototoxicity (see
Adult: IV/IM 1–2 g synthesis, thus Appendix F).
q12h killing the Skin: Rash, pruritus.  Report onset of loose stools or
Child: IV/IM 40–80 bacterium. diarrhea. If diarrhea is severe,
mg/kg/d divided q12h Generally less suspect pseudomembranous colitis
(max: 6 g/d) active against (see Appendix F) caused
susceptible Staphy by Clostridium difficile. Check
Surgical Prophylaxis lococci than first temperature. Report fever and
Adult: IV/IM 1–2 g generation severe diarrhea to physician; drug
30–60 min before cephalosporins are should be discontinued.
surgery but has broad
spectrum of
 NCM 106 SY 2020-2021

activity against
gram-negative Patient & Family Education
bacteria when
compared to first  Report promptly S&S of
and second superinfection (see Appendix F).
generation  Report loose stools or diarrhea.
cephalosporins.  Do not breast feed while taking this
drug without consulting physician.
 NCM 106 SY 2020-2021

DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE NURSING RESPONSIBILITIES

OF ACTION EFFECT
Broad-spectrum Parenteral use History of hypersensitivity Special Assessment & Drug Effects
GENERIC NAME aminoglycoside restricted to to or toxic reaction with Senses: Ototoxicity
GENTAMICIN antibiotic derivedtreatment of any aminoglycoside (vestibular  Lab tests: Perform C&S and renal
SULFATE from Micromono serious infections antibiotic. Safe use during disturbances, function prior to first dose and
spora purpurea. of GI, respiratory, pregnancy (category C) or impaired hearing), periodically during therapy; therapy
BRAND NAME and urinary tracts, lactation is not established. optic neuritis.  may begin pending test results.
Garamycin, Garamycin Active against a CNS, bone, skin, Determine creatinine clearance and
Ophthalmic, Genoptic wide variety of and soft tissue Cautious Use CNS: neuromuscular serum drug concentrations at
gram-negative (including burns) blockade: skeletal frequent intervals, particularly for
CLASSIFICATION bacteria, when other less Impaired renal function; muscle weakness, patients with impaired renal
ANTIINFECTIVE; including Escher toxic antimicrobial history of eighth cranial apnea, respiratory function, infants (renal immaturity),
AMINOGLYCOSIDE ichia coli, agents are (acoustic) nerve paralysis (high older adults, patients receiving high
ANTIBIOTIC Enterobacter, ineffective or are impairment; preexisting doses); arachnoiditis doses or therapy beyond 10 d,
Klebsiella, contraindicated. vertigo or dizziness or (intrathecal use).  patients with fever or extensive
DOSAGE Proteus, Pseudo Has been used in tinnitus; dehydration, burns, edema, obesity.
Moderate to Severe monas combination with fever; use in older adults, CV: hypotension or  Repeat C&S if improvement does
Infection aeruginosa, and  other antibiotics. premature infants, hypertension.  not occur in 3–5 d; reevaluate
Adult: IV/IM 1.5–2 Serratia sp. Also Also used neonates, and infants; therapy.
mg/kg loading dose effective against topically for obesity, neuromuscular GI: Nausea,  Note: Dosages are generally
followed by 3–5 certain gram- primary and disorders: myasthenia vomiting, transient adjusted to maintain peak serum
mg/kg/d in 2–3 divided positive secondary skin gravis, parkinsonian increase in AST, gentamicin concentrations of 4– 10
doses Intrathecal 4–8 organisms, infections and for syndrome; hypocalcemia, ALT, and serum g/mL, and trough concentrations of
mg preservative free particularly superficial heart failure, topical LDH and bilirubin; 1–2 g/mL. Peak concentrations
q.d. Topical 1–2 drops penicillin- infections of applications to widespread hepatomegaly, above 12 g/mL and trough
of solution in eye q4h sensitive and external eye and areas. splenomegaly.  concentrations above 2 g/mL are
up to 2 drops q1h or some methicillin- its adnexa. associated with toxicity.
small amount of resistant strains Hematologic: Increa  Draw blood specimens for peak
ointment b.i.d. or t.i.d. of Staphylococcu sed or decreased serum gentamicin concentration 30
Child: IV/IM 6–7.5 s Unlabeled reticulocyte counts; min–1h after IM administration,
 NCM 106 SY 2020-2021

mg/kg/d in 3–4 divided aureus (MRSA). granulocytopenia, and 30 min after completion of a

doses Intrathecal >3 Uses thrombocytopenia 30–60 min IV infusion. Draw blood
mo, 1–2 mg (fever, bleeding specimens for trough levels just
preservative free q.d. Prophylaxis of tendency), before the next IM or IV dose. Use
Neonate: IV/IM 2.5 bacterial thrombocytopenic nonheparinized tubes to collect
mg/kg q12–24h endocarditis in purpura, anemia.  blood.
patients  Check baseline weight and vital
Acute Pelvic undergoing Body as a signs; determine vestibular and
Inflammatory Disease operative Whole: Hypersensiti auditory function before therapy
Adult: IV/IM 2 mg/kg procedures or vity (rash, pruritus, and at regular intervals. Check
followed by 1.5 mg/kg instrumentation. urticaria, exfoliative vestibular and auditory function
q8h dermatitis, again 3–4 wk after drug is
eosinophilia, burning discontinued (the time that deafness
Prophylaxis of sensation of skin, is most likely to occur).
Bacterial drug fever, joint  Monitor I&O. Keep patient well
Endocarditis pains, laryngeal hydrated to prevent chemical
Adult: IV/IM 1.5 edema, irritation of renal tubules. Report
mg/kg 30 min before anaphylaxis).  oliguria, unusual appearance of
procedure, may repeat urine, change in I&O ratio or
in 8 h Urogenital: Nephrot pattern, and presence of edema
Child: IV/IM < 27 kg, oxicity: proteinuria, (prolongs elimination time).
2 mg/kg 30 min before tubular necrosis,  Note: Ototoxic effect (see
procedure, may repeat cells or casts in Appendix F) is greatest on the
in 8 h urine, hematuria, vestibular branch of eighth cranial
rising BUN, (acoustic) nerve (symptoms:
nonprotein nitrogen, headache, dizziness or vertigo,
serum nausea and vomiting with motion,
creatinine; decreased ataxia, nystagmus). However,
creatinine clearance.  damage to the auditory branch
(tinnitus, roaring noises, sensation
Other: Local of fullness in ears, hearing
NCM 106 SY 2020-2021

irritation and pain impairment) may also occur.

following IM use; Report promptly to prevent
thrombophlebitis, permanent damage.
abscess,  Watch for S&S of bacterial
superinfections, overgrowth (opportunistic
syndrome of infections) with resistant or
hypocalcemia nonsusceptible organisms (diarrhea,
(tetany, weakness, anogenital itching, vaginal
hypokalemia, discharge, stomatitis, glossitis).
hypomagnesemia). 
Patient & Family Education
Topical and
Ophthalmic: Photose  Note: When using topical
nsitivity, applications: Avoid excessive
sensitization, exposure to sunlight because of
erythema, pruritus; danger of photosensitivity;
burning, stinging, withhold medication and notify
and lacrimation physician if condition fails to
(ophthalmic improve within 1 wk, worsens, or
formulation). signs of irritation or sensitivity
occur; and apply medication as
directed and only for length of time
prescribed (overuse can result in
superinfections).
 Do not breast feed while taking this
drug without consulting physician.
 NCM 106 SY 2020-2021

DRUGS MECHANIS INDICATION CONTRAINDICATION ADVERSE NURSING RESPONSIBILITIES

M OF EFFECT
ACTION
Synthetic Asymptomatic and Blood dyscrasias; active Body as a Assessment & Drug Effects
GENERIC NAME compound symptomatic CNS disease; first Whole: Hypersensiti
METRONIDAZOLE with direct trichomoniasis in trimester of pregnancy vity (rash, urticaria,  Discontinue therapy immediately if
trichomonacid females and (category B), lactation. pruritus, flushing), symptoms of CNS toxicity (see
BRAND NAME al and males; acute fever, fleeting joint Appendix F) develop. Monitor
Flagyl, Flagyl ER, Flagyl amebicidal intestinal Cautious Use pains, overgrowth especially for seizures and
IV RTU, Flagyl activity as amebiasis and of Candida.  peripheral neuropathy (e.g.,
375, Metizol, Metric well as amebic liver Coexistent candidiasis; numbness and paresthesia of
21, Metro antibacterial abscess; second and third trimesters CNS: Vertigo, extremities).
I.V., MetroGel, MetroGel activity preoperative of pregnancy (category B); headache, ataxia,  Lab tests: Obtain total and
Vaginal, MetroLotion,  against prophylaxis in alcoholism; liver disease. confusion, differential WBC counts before,
Noritate, Protostat anaerobic colorectal surgery, irritability, during, and after therapy, especially
bacteria and elective depression, if a second course is necessary.
CLASSIFICATION some gram- hysterectomy or restlessness,  Monitor for S&S of sodium
ANTIINFECTIVE;  negative vaginal repair, and weakness, fatigue, retention, especially in patients on
ANTITRICHOMONAL;  bacteria. emergency drowsiness, corticosteroid therapy or with a
AMEBICIDE;  appendectomy. IV insomnia, history of CHF.
ANTIBIOTIC Effective metronidazole is paresthesias, sensory  Monitor patients on lithium for
against Tricho used for the neuropathy (rare).  elevated lithium levels.
DOSAGE monas treatment of  Report appearance of candidiasis or
Trichomoniasis, vaginalis, serious infections GI: Nausea, vomitin its becoming more prominent with
Giardiasis, Gardnerella Entamoeba caused by g, anorexia, therapy to physician promptly.
Adult: PO 2 g once or 250 histolytica, an susceptible epigastric distress,  Repeat feces examinations, usually
mg t.i.d.; 375 mg b.i.d. or d Giardia anaerobic bacteria abdominal cramps, up to 3 mo, to ensure that amebae
500 mg b.i.d. for 7 lamblia. in intraabdominal diarrhea, have been eliminated.
d Vaginal Apply once or Exhibits infections, skin constipation, dry
twice daily times 5 d antibacterial infections, mouth, metallic or Patient & Family Education
Child: PO 15 mg/kg/d in 3 activity gynecologic bitter taste, proctitis. 
 NCM 106 SY 2020-2021

divided doses for 7–10 d infections,

Infant: PO 10–30 mg/kg/d against septicemia, and for Urogenital: Polyuria,  Adhere closely to the established
for 5–8 d obligate both pre- and dysuria, pyuria, regimen without schedule
anaerobic postoperative incontinence, interruption or changing the dose.
Amoebiasis bacteria, prophylaxis, cystitis, decreased  Refrain from intercourse during
Adult: PO 500–750 mg gram-negative bacterial libido, dyspareunia, therapy for trichomoniasis unless
t.i.d. anaerobic vaginosis. Topical dryness of vagina male partner wears a condom to
Child: PO 35–50 mg/kg/d bacilli, : Rosacea. and vulva, sense of prevent reinfection.
in 3 divided doses and Clostridia pelvic pressure.   Have sexual partners receive
. Unlabeled concurrent treatment.
Anaerobic Infections Microaerophil Special Asymptomatic trichomoniasis in
Adult: PO 7.5 mg/kg q6h
Uses Senses: Nasal
ic Streptococc the male is a frequent source of
(max: 4 g/d) IV Loading i and most congestion.  reinfection of the female.
Treatment of
Dose 15 mg/kg IV aerobic  Do not drink alcohol during
pseudomembranou
Maintenance Dose 7.5 bacteria are CV: ECG changes therapy; may induce a disulfiram-
s colitis, Crohn's
mg/kg q6h (max: 4 g/d) resistant. (flattening of T type reaction (see Appendix F).
disease, H.
Child: PO/IV 30 mg/kg/d wave). Avoid alcohol or alcohol-
pylori eradication.
divided q6h (max: 4 g/d) containing medications for at least
Neonate: PO/IV 7.5–15 48 h after treatment is completed.
mg/kg/d divided q12–48h  Urine may appear dark or reddish
brown (especially with higher than
Pseudomembranous recommended doses). This appears
Colitis to have no clinical significance.
Adult: PO 250–500 mg  Report symptoms of candidal
t.i.d. IV 250–500 mg t.i.d. overgrowth: Furry tongue, color
or q.i.d. changes of tongue, glossitis,
Child: PO 30 mg/kg/d stomatitis; vaginitis, curd-like,
divided q6h times 7 d milky vaginal discharge; proctitis.
Treatment with a candidacidal
Bacterial Vaginosis agent may be indicated.
Adult: PO (Flagyl ER)  Do not breast feed while taking this
 NCM 106 SY 2020-2021

750 mg q.d. times 7 d drug.

Rosacea
Adult: Topical Apply
0.75% gel as a thin film to
affected area b.i.d.; apply
1% gel as a thin film to
affected area q.d.