West Visayas State University

COLLEGE OF NURSING
Luna St., La Paz, Iloilo City 5000
Iloilo, Philippines
sc1313 * Telefax No.: (033) 320-0879
* Trunkline: (063) (033) 320-0870 to 78 loc.
* Website: www.wvsu.edu.ph * Email Address: [email protected]

DRUG STUDY

Name of Patient: M. H. G. C. Attending Physician: Dr. L

Age: 28 years old Ward/Bed Number: OB ward, Bed 6 Impression/Diagnosis: Admission Diagnosis: IUP 40 1/7 weeks G3P2
Principal Diagnosis: PU, del to a live FT baby boy
via NSVD cephalic presentation, AS 8/10 BW
3000g, G3p3 (3003)

Dosage, Route,
Special
Name of Drug Frequency and Mechanisms of Action Indication Adverse Reactions Nursing Responsibilities
Precautions
Timing
Generic: Dosage: Oxytocin promotes uterine Indicated to produce ● Explain purpose of
contractions by increasing uterine contractions premature ventricular Because of the oxytocin as well as the side
oxytocin 10 “U”/amp, 1 amp intracellular concentrations of during the third stage of contractions, variability of the effects and adverse
calcium in uterine myometrial labor and to control hypertensive combination of reactions
tissue, thereby increasing the postpartum bleeding or episodes, cardiac factors which may
activity of the calcium- arrhythmia, ● Assess for hypersensitivity
hemorrhage be present in the to oxytocin
Route: dependent phosporylating Subarachnoid
conditions listed in
Brand: enzyme myosin light-chain hemorrhage, Water ● Assess baseline data
To promote lactation in the
IM kinase intoxication, before infusion, including
case of faulty milk contraindications,
Popicin postpartum maternal pulse and BP,
ejection hemorrhage, pelvic the definition of
“unusual uterine history and uterine
hematoma, uterine
circumstances” activity, and review history
rupture, Anaphylactic
McCuistion, L.E. , et al. (2019) reaction, must be left to the of any contraindications.
Frequency:
Pharmacology: A Patient- hypertensive judgement of the ● Monitor and record uterine
once Centeredd Nursing Process episodes physician. The contractions, heart rate,
Approach 9e, p 742-744. decision can be BP, and character of blood
Philippines: Elsevier Inc. made only by loss every 15 minutes after
carefully weighing delivery.
the potential
● Explain use and
benefits which
administration to patient
Timing: oxytocin can
provide in a given and folks.
After delivery of case against rare ● Have emesis basin ready
the fetus; before but definite in case vomiting occurs.
delivery of ● Monitor for signs of uterine
Classification placenta Contraindications Side Effects potential for the rupture including sudden
Hypersensitivity, Cardiovascular: drug to produce increased pain, loss of
Functional: hypertoxicity or uterine contractions,
cephalopelvic Increased blood
tetanic spasms. hypovolemic shock and
disproportion, pressure
Uterotonic unfavorable fetal hemorrhage.
agent; hormone ● Assess and monitor for
presentations, obstetrical Gastrointestinal:
emergencies where the nausea and vomiting signs of adverse effects
Chemical: benefit-to-risk ratio for and refer immediately.
either the fetus or the
Oxytoxic, mother requires surgical
uterine-active intervention, hyperactive
agent
or hypertonic uterus,
cases where vaginal
delivery is
contraindicated such as
invasive carcinoma,
herpes genitalis, total
placenta previa, vasa
previa, and prolapsed
cord
 Dosage, Route,
Name of Drug Frequency and Mechanism of Action Indication Adverse Reactions Special Precautions Nursing Responsibilities
Timing
Dosage: Broad spectrum Treatment of infections CNS:seizures,anxiety,
Fatal hypersensitivity
bactericidal, acid stable, caused by susceptible confusion, agitation,
reactions have been
Generic: 500 mg/ cap semisynthetic stains of gram positive dizziness, reversible
reported in patients on
1 tab aminopenicillin. Act by and gram negative hyperactivity, anxiety,
penicillin therapy.
amoxicillin trihydrate inhibiting microprotein microorganisms insomnia, behavioral
Serious anaphylactoid
synthesis in cell wall of changes
reactions require
rapidly multiplying GI:diarrhea, nausea,
Route: immediate emergency
bacteria. Ineffective in psuedomembranous
Per Orem treatment with
most staphylococcal colitis, vomiting
Brand: epinephrine.
infections since it is GU:interstitial nephritis,
destroyed by beta nephropathy
Harbimox lactamase Hematologic:agranuloc Clostridium difficile-
ytosis, leukopenia, associated diarrhea
thrombocytopenia, (CDAD) and colitis
(Wilson, B. A., Shannon, Tell patient to take entire quantity of
anemia have been reported
M. T., & Stang, C. L. drug exactly as prescribed, even after
Other:anaphylaxis, with the use of nearly
(2005). Prentice Hall feeling better.
overgrowth of all
Nurse's Drug Guide.
Upper Saddle River, New nonsusceptible
Antibacterial agents, Instruct patient to take drug with or
Frequency: Jersey: Pearson organisms
including amoxicillin, without food, except extended-release
Education, Inc)
and may range in tablets, which are taken with a meal.
Classification TID x 7 days Contraindications Side Effects severity from mild to life
threatening. It is Tell patient to swallow extended-
Functional: important to consider release tablets whole and not to
Bloating chew, crush, or split them.
Timing: Contraindicated in this diagnosis in
Broad-spectrum patients hypersensitive patients who present
to drug or other Diarrhea with diarrhea following Tell patient to notify prescriber if rash,
antiinfective 8,1,6
penicillins administration of fever, or chills develop. A rash is the
Headache antibacterial agents. most common allergic reaction,
Chemical:
Use cautiously in especially if allopurinol is being taken.
patients with other Dizzieness During administration of
Aminopenicillin beta
lactamase inhibitor drug allergies high doses of Tell parent to place drops directly on
especially to Nausea and vomitng amoxicillin, it is child’s tongue for swallowing or add to
cephalosporins) recommended to formula, milk, fruit juice, water, ginger
because of possible Nose bleeds maintain adequate fluid ale, or other cold drink for immediate
cross-sensitvity. intake and urinary and complete consumption.
 Name of Drug Dosage, Mechanism of Indication Adverse Reaction Special Nursing Responsibilities
Route, Action Precautions
Frequency,
Timing
Generic: Dosage: Ferrous sulfate Assess nutritional status
 replaces Ferrous sulfate is ferrous sulfate and bowel function.
200mg/400 mcg iron stores found in indicated as CV: collapse Before taking this
Ferrous Sulfate + per tab, 1 tab hemoglobin in red prophylaxis and GI: hematemesis; medication, tell your Determine medical history and
Folic acid OD blood treatment for iron- aggravation of doctor or pharmacist check for
cells, myoglobin and deficiency anemia. existing GI conditions if you are allergic to contraindications.
Route: other Systemic: shock; it.
Brand: PO heme enzymes in the metabolic acidosis; Caution that dizziness may occur
Folic acid is
body. Additionally, anaphylaxis This medication when taking the drug.
indicated
None ferrous should not be used if
sulfate allows the to prevent neural folic acid you have certain Emphasize the importance of oral
Frequency:
Once a day transportation of tube medical conditions care to prevent tooth discoloration.
oxygen defects during Respiratory: like iron overload
Classification pregnancy; also
via hemoglobin. bronchospasm disorder (e.g., Advise that nausea and
Timing: Approximately 60% of indicated to prevent Skin: severe pruritus hemochromatosis, vomiting may occur, have emesis
iron is stored in premature birth, low Systemic: anaphylaxis hemosiderosis). basin ready in case of vomiting.
Functional: hemoglobin in red
one hour before fetal birthweight and
or two hours blood abruptio placentae. Side effects If your brand of iron Encourage increase water intake if
iron and vitamin cells, while 9% is supplement also diarrhea or constipation occurs;
supplements after meal
stored Contraindications ferrous sulfate contains folic acid, be educate about the benefits of fiber-
in myoglobin and other sure to tell your rich foods for constipation.
Chemical: heme enzymes. CNS: drowsiness doctor or pharmacist
hypersensitivity to
Additionally, 25% is folic acid or ferrous GI: teeth if you have vitamin Inform that black tarry
Iron (II) sulfate held discoloration; nausea; B12 deficiency stool and urine
sulfate
in reserve in vomiting; diarrhea; (pernicious anemia) discoloration are common side
reticulocytes hemolytic and constipation; before taking it. Folic effects of the medication.
of the liver, spleen and pernicious anemia irritation; black tarry acid may falsely
bones (McCuistion, stool; epigastric pain improve certain Warn that rashes or
2019). hemosiderosis GU: urine laboratory tests for erythema may occur and advice to
Folic acid is essential Discoloration vitamin B12 report if it
for peptic ulcer deficiency without becomes severe.
body growth. It is folic acid actually treating this
needed ulcerative colitis anemia. Encourage to take
for DNA synthesis, and renal disease GU: yellow supplement with orange juice or
without folic acid, discoloration of urine Liquid preparations of citrus-rich fruits
cellular Skin: rash; erythema this product may and juices to enhance
division is disrupted Systemic: general contain sugar and/or absorption.
(McCuistion, 2019). malaise alcohol. Caution is
Folic acid, as it is advised if you have Advise to take medication 1 hour
biochemically diabetes, alcohol before or 2 hours
inactive, is converted to dependence, or liver after meal. In case of
tetrahydrofolic acid and disease.  gastric irritation, encourage to take
methyltetrahydrofolate with food.
by During pregnancy,
dihydrofolate reductase this medication Advise to take medication 2
(DHFR). These folic should be used only hours before or 4 hours
acid when clearly needed. after taking antacids.
congeners are Discuss the risks and
transported across benefits with your Advise to not chew but to swallow
cells doctor. the tablet whole with one glass of
by receptor water or juice.
-mediated This medication
endocytosis where they passes into breast Monitor for any signs of
are needed to maintain milk. Consult your adverse reactions and refer
normal erythropoiesis, doctor before breast- immediately.
synthesize purine and feeding.
thymidylate nucleic
acids, Folic acid in doses
interconvert amino above 0.1 mg daily
acids, may obscure
methylate tRNA, and pernicious anemia in
generate and use that hematologic
formate. Using vitamin remission can occur
B12 as a cofactor, folic while neurologic
acid can normalize manifestations
high remain progressive.
homocysteine levels by There is a potential
remethylation of danger in
homocysteine to administering folic
methionine via acid to patients with
methionine synthetase undiagnosed anemia,
(Mahmood, 2014). since folic acid may
References: obscure the
Mahmood, L. (2014). diagnosis of
The pernicious anemia by
metabolic processes of alleviating the
folic acid and vitamin hematologic
B12 deficiency. manifestations of the
Retrieved disease while
from http://www.jhrr. allowing the
org/ article.asp? neurologic
 issn=2394 complications to
-2010; progress. This may
year=2014;volume=1; result in severe
issue=1;spage=5;epag nervous system
e=9 damage before the
; correct diagnosis is
aulast=Mahmood, on made. Adequate
October 20, 2019. doses of vitamin B12
McCuistion, L., et.al. may prevent, halt, or
(2019). Pharmacology: improve the
A patient-centered neurologic changes
nursing caused by pernicious
process approach (9th anemia.
ed). Reproductive and
gender-related drugs
(p.
714-716). Singapore:
Elsevier, Pte. Ltd.

Dosage,Route,
Name of Drug Frequency Mechanism of Action Indication Adverse Special Precautions Nursing Responsibilities
and Timing Reactions
Generic: Dosage: Lidocaine blocks nerve To provide topical CNS: anxiety; Use cautiously in: ● Question for hypersensitivity to
Lidocaine 20mg/ mL (2%) impulses by decreasing anesthesia for skin confusion; difficulty ● renal or hepatic lidocaine, amide anesthetics.
hydrochloride the permeability of or mucous speaking; dizziness; disorders, Obtain baseline B/P, pulse,
Route: neuronal membranes to membranes hallucinations; lethargy; inflammation or respiratory rate, EKG, serum
IM sodium, which produces paresthesia; light- electrolytes.
sepsis in injection
Brand: ● Monitor EKG, vital signs closely
local anesthesia headedness; fatigue; area
Frequency: during and following drug
Senzitene drowsiness; headache; ● labor or delivery
once administration for cardiac
persist- ent sensory, ● breastfeeding performance. If EKG shows
Timing:
motor, or autonomic patients. arrhythmias, prolongation of PR
During deficit of lower spinal interval or QRS complex, inform
episiorrhaphy segment; septic physician immediately.
Jones and Bartlett
meningitis; seizures ● Assess pulse for rhythm, rate,
Learning. (2015) 2015
quality.
Nurse’s Drug Handbook.
14e, p 672-674.
CV: bradycardia, ● Assess B/P for evidence of
hypotension, new or hypotension.
Burlington, MA: Jones and
worsening arrhythmias, ● Monitor for therapeutic serum
Bartlett Learning.
cardiac arrest level (1.5–6 mcg/mL). For
lidocaine given by all routes,
EENT: diplopia, monitor vital signs, LOC.
abnormal vision ● Drowsiness should be
considered a warning sign of high
serum levels of lidocaine.
GI: nausea, vomiting,
Therapeutic serum level: 1.5–6
dry mouth mcg/mL; toxic serum level:
greater than 6 mcg/mL
GU: urinary retention

Metabolic:
methemoglobinemia
Respiratory:
suppressed cough
reflex, respiratory
depression, respiratory
arrest

Skin: rash; urticaria;

pruritus; ery- thema;
contact dermatitis;
cutaneous lesions;
tissue irritation,
 sloughing, and
necrosis

Other: fever; edema;

infection, burn- ing,
stinging, tenderness,
and swelling at
injection site;
anaphylaxis

Classification Contraindications Side Effects

Functional: Hypersensitivity to ● Low blood
Antidysrhythmic lidocaine. Adams- pressure (hypotension
Stokes syndrome, )
hypersensitivity to ● Swelling (edema)
amide-type local ● Redness at injection
Chemical: site
anesthetics,
supraventricular ● Small red or purple
Aminoacyl amide spots on skin
arrhythmias, Wolff-
Parkinson-White ● Skin irritation
● Constipation
syndrome. Severe
● Nausea
degree of SA, AV, or ● Vomiting
intraventricular heart ● Confusion
block (except in ● Dizziness
patients with ● Headache
functioning ● Numbness and
pacemaker). tingling
● Drowsiness
Cautions: Hepatic ● Tremor
disease, marked ● Irritation symptoms
hypoxia, severe (topical products); i.e.,
redness, swelling
respiratory
depression,
hypovolemia,
incomplete heart.
History of malignant
 hyperthermia, shock,
elderly patients, HF.

Dosage,Route,
Name of Drug Frequency Mechanism of Action Indication Adverse Special Precautions Nursing Responsibilities
and Timing Reactions
Generic: Dosage: Cefuroxime is like For treatment of Anaphylaxis, 1. Caution is Assessment History: Hepatic and renal
cefuroxime 500 mg 1 tab Penicillins which interferes Urinary Tract nephrotoxicity, advised when impairment, lactation, pregnancy
with bacterial cell wall Infection pseudomembranous administering cefuroxime
Route: synthesis by inhibiting the colitis. to patients with renal Physical: Skin status, LFTs, renal
Oral bacterial enzyme that is impairment or renal function tests, culture of affected area,
Brand: necessary for cell division failure. sensitivity tests
Frequency: and cellular synthesis. The 2. Cefuroxime is
BID bacteria die of cell lysis or excreted in human Interventions
cell breakdown. breast milk in small Culture infection, and arrange for
Timing: (McQuistion et. Al 2019) quantities thus take extra sensitivity tests before and during
Classification 86 Contraindications Side Effects caution with use during therapy if expected response is not
breast-feeding seen.
Functional: Allergy to medications Large doses can cause
3. Excercise
Anti-infective similar to cefuroxime cerebral irritation and
caution for pregnant Give oral drug with food to decrease GI
convulsions; nausea,
women. It is classified as upset and enhance absorption.
Phenylketonuria vomiting, diarrhea, GI
Chemical: pregnancy risk category
disturbances; erythema
Cephalosporin (2nd B Give oral drug to children who can
cephalosporin multiforme, Stevens-
generation) 4. Patients with swallow tablets; crushing the drug
hypersensitivity or Johnson syndrome,
diabetes mellitus should results in a bitter, unpleasant taste.
cephamycin epidermal necrolysis.
be aware that cefuroxime
hypersensitivity
therapy may interfere Have vitamin K available in case
with certain glucose test hypoprothrombinemia occurs.
 products or assays.
Discontinue if hypersensitivity reaction
occurs.

Teaching points Oral drug Take full

course of therapy even if you are feeling
better. This drug is specific for this
infection and should not be used to self-
treat other problems.

Swallow tablets whole; do not crush

them. Take the drug with food.

Inform patient of side effects: Stomach

upset or diarrhea. Report severe
diarrhea with blood, pus, or mucus; rash;
difficulty breathing; unusual tiredness,
fatigue; unusual bleeding or bruising;
unusual itching or irritation.

Educate patient on how to manage said

effects.

Dosage,
Route,
Name of Drug Mechanisms of Action Indication Adverse Reactions Special Precautions Nursing Responsibilities
Frequency and
Timing
Generic: Dosage: Mefenamic acid inhibits For mild to moderate Caution patient with: ● Check doctor’s order
mefenamic acid the activity of the pain Anaphylactic reaction, ● Assess pain score
500 mg/tab enzymes cyclo- fluid retention, Risk factors of ● Monitor vital signs
oxygenase I and II, anemia, Cardiovascular events ● Assess for history of allergies to
resulting in a decreased hyperkalemia, (hypertension,
formation of the leukopenia, NSAIDS
hyperlipidemia,
Brand: Route: precursors of thrombocytopenic diabetes mellitus), mild ● Educate patient regarding desired
prostaglandins and purpura, to moderate heart side effects and adverse
Myrefen PO thromboxanes megaloblastic anemia failure, hypovolemia, reactions
dehydration Give drug with food and with full
glass of water
Debilitated patient ● Do not increase or double the
Frequency:
dose, follow exactly as prescribed
Renal and hepatic
Q6H and indicated
impairment
● Do not break, chew or crush
Elderly capsule and tablet
● Do not administer with
Pregnancy and anticoagulants and other drug
lactation that causes GI upset
Timing:
● Do not drive heavy machineries
PRN ● Monitor blood glucose for loss of
glycemic control if diabetic
● Monitor for adverse effects
● Discontinue if adverse effects
Classification Contraindications Side Effects occur
Hypersensitivity, Abdominal pain,
Functional: recurrent peptic constipation,
ulcer/hemorrhage indigestion, diarrhea,
Analgesic/ History of GI nausea and vomiting,
Antipyretic
bleeding, heartburn, GI ulcers,
inflammatory bowel dizziness, headache,
disease, severe heart itching, tinnitus,
Chemical: failure, asthma, hepatic toxicity
bronchospasm,
NSAIDS rhinitis, angioedema,
(Nonsteroidal Anti- urticaria, allergic
inflammatory
compound) reactions with
NSAIDS
Pregnancy (Category
C) and lactation

Dosage,
Route,
Name of Drug Mechanisms of Action Indication Adverse Reactions Special Precautions Nursing Responsibilities
Frequency and
Timing
Generic: Dosage: Paracetmaol exhibits Relief of fever, minor Do not exceed ● Use liquid form for children and
paracetamol analgesic and aches, and pain Hepatic toxicity recommended dose patient with difficulty swallowing
500 mg/tab antipyretic activity by ● In children, don’t exceed 7 doses
inhibiting prostaglandin Bronchospasm to Discontinue use if
in 24 hours; in adults, don’t
synthesis. It produces those who are symptoms persists
analgesia by elevating sensitive exceed 8 doses in 24 hours.
Brand: Route: the pain threshold and Keep out of reach of ● tell patient to consult a doctor
antipyresis through children before giving the drug to children
 action of the below 2 years-old
PO hypothalamic heat- Contact physician in ● advise patient that drug is for
regulating center. case of accidental short-term use.
overdose

Frequency:

Every 4-6 hours

Timing:

Classification Contraindications Side Effects

Hypersensitivity to Nausea and vomiting,
Functional: paracetamol diaphoresis and
Repeated general malaise,
Analgesic/ administration in dizziness, drowsiness,
Antipyretic
patients with anemia, constipation, dry
cardiac damage, mouth, blurred vision.
renal damage, and
Chemical: hepatic damage.

NSAIDS
(Nonsteroidal Anti-
inflammatory
compound)