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University of the PhilippinesThe Health Sciences Center

COLLEGE OF NURSINGSotejo Hall, Pedro Gil Street, Manila

Drug Study

DRUG ORDER

(Genericname,Dosage,Route,

Frequency,etc.)

PHARMACOLOGIC ACTION OF

DRUG

INDICATIONS ANDCONTRAINDICATIONS

ADVERSE EFFECTSOF THE DRUG

DESIRED ACTIONON THE CLIENT

NURSINGRESPONSIBILITIES

/PRECAUTIONS

1. Paracetamol(250mg/5ml)3ml q4h forfever

2. Paraceta

mol 145mg IVq4h for T >38oC

Antipyretic:Reduces fever byacting directly onthe hypothalamicheat-regulatingcenter to cause

vasodilation andsweating, whichhelps dissipateheat.

Analgesic: Siteand mechanismof action unclear

Indications- Analgesic-antipyretic inpatients with aspirinallergy, hemostaticdisturbances, bleedingdiatheses, upper GI

disease, gouty arthritis- Arthritis and rheumaticdisorders involvingmusculoskeletal pain (butlacks clinically significantantirheumatic and anti-inflammatory effects)- Common cold, flu, otherviral and bacterialinfections with pain andfever- Unlabeled use:

Prophylactic for childrenreceiving DPT vaccinationto reduce incidence offever and pain

Contraindications- Contraindicated withallergy toacetaminophen.- Use cautiously withimpaired hepaticfunction, chronic

alcoholism, pregnancy,lactation.

CNS: HeadacheCV: Chest pain,dyspnea,myocardialdamage whendoses of 58 g/day

are ingested daily forseveral weeks orwhen doses of 4g/day are ingestedfor 1 yrGI: Hepatictoxicity andfailure, jaundiceGU: Acute kidneyfailure, renal tubularnecrosisHematologic:

Methemoglobinemiacyanosis;hemolytic anemiahematuria, anuria;neutropenia,leucopenia,pancytopenia,thrombocytopenia,hypoglycemiaHypersensitivity:Rash, fever

Fever reduction - Monitor liverfunction studies;may cause hepatictoxicity at doses>4g/day

- Monitor renal

function studies;albumin indicatesnephritis

- Monitor bloodstudies, especiallyCBC and pro-timeif patient is onlong-term therapy.

- Check I&O ratio;decreasing outputmay indicate renalfailure.

- Assess for feverand pain

- Assesshepatotoxicity:dark urine, clay-colored stools

- Assess allergicreactions: rash,urticaria

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Ibuprofen(200mg/5ml)4ml q6h forT>/= 39oC

Inhibitsprostaglandinsynthesis bydecreasingenzyme neededfor biosynthesis;analgesic, anti-inflammatory,

antipyretic

Indications-Relief of signs andsymptoms of rheumatoidarthritis andosteoarthritis

-Relief of mild tomoderate pain-Treatment of primary

dysmenorrhea-Fever reduction-Unlabeled uses:Prophylactic for migraine;abortive treatment formigraine

Contraindications-Contraindicated withallergy to ibuprofen,salicylates, or otherNSAIDs (more common in

patients with rhinitis,asthma, chronic urticaria,nasal polyps).

CNS: Headache,dizziness,somnolence,insomnia, fatigue,tiredness, dizziness,tinnitus,ophthalmologiceffects

CV: Hypertension,palpitations,arrhythmiaDermatologic:Rash, pruritus,sweating, drymucous membranes,stomatitisGI: Nausea,dyspepsia, GI pain,diarrhea, vomiting,constipation,

flatulence, GIbleedingGU: Dysuria, renalimpairment,menorrhagiaHematologic:Bleeding, plateletinhibition with higherdoses, neutropenia,eosinophilia,leukopenia,pancytopenia,

aplastic anemia,decreased Hgb orHct, bone marrowdepressionRespiratory:Dyspnea,hemoptysis,pharyngitis,bronchospasm,rhinitisOther: Peripheraledema,

anaphylactoidreactions to

Fever reduction - Assess pain- Assess

musculoskeletalstatus: ROM beforedose and 1 hrafter.

- Monitor liverfunction studies

- Monitor renalfunction studies- Monitor blood

studies: CBC, Hgb,Hct, protime ifpatient is on long-term therapy

- Check I&O ratio- Assess

hepatotoxicity- Assess for allergic

reactions, visual

changes andototoxicity- Identify prior drug

history- Identify fever:

length of time inevidence andrelated symptoms

Precautions:- Pregnancy B,

lactation, children,

bleeding disorders,GI disorders,cardiac disorders,hypersensitivity toother anti-inflammatoryagents, elderly,CHF

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anaphylacticshock

Cotrimoxazole(200mg/5ml)5ml BID

Blocks synthesisof tetrahydrofolicacid;combination

blocks twoconsecutive steps

Indications- Uncomplicated UTIscaused by susceptible

strains ofE. coli, Proteusmirabilis, Klebsiella

Dermatologic:Rash, pruritus,exfoliative dermatitis

GI: Epigastricdistress, nausea,

Prevent infection - Assess allergicreactions

- Monitor I&O ratio

- Monitor kidneyfunction

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in bacterialsynthesis ofessential nucleicacids, protein

pneumoniae,Enterobacterspecies, andcoagulase-negativeStaphylococcus species,including Staphylococcussaprophyticus- Treatment of acute otitismedia due to susceptible

strains ofS. pneumoniaeand H. influenza inchildren

Contraindications- Allergy to trimethoprim,pregnancy (teratogenic inpreclinical studies),megaloblastic anemiadue to folate deficiency.

vomiting, glossitisHematologic:Thrombocytopenia,leukopenia,neutropenia,megaloblasticanemia,methemoglobinemia,

elevated serumtransaminase andbilirubin, increasedBUN and serumcreatinine levelsOther: Fever

- Assess type ofinfection; obtainC&S beforestarting therapy

- Assess blooddyscrasias

Precautions:

- Pregnancy C,renal disease,eldery, G6PDdeficiency,impairedhepatic/renaldisease,possible folatedeficiency,severeallergy,bronchial

asthmaAllopurinol100mg/tab 1tab BID

Inhibits theenzymeresponsible forthe conversion ofpurines to uricacid, thusreducing theproduction of uricacid with adecrease inserum and

sometimes inurinary uric acidlevels, relievingthe signs andsymptoms of gout

Indications:- Management of thesigns and symptoms ofprimary and secondarygout- Management of patientswith malignancies thatresult in elevations ofserum and urinary uricacid- Management of patients

with recurrent calciumoxalate calculi whosedaily uric acid excretionexceeds 800 mg/day(males) or 750 mg/day(females)- Orphan drug use:Treatment of Chagas'disease; cutaneous andvisceral leishmaniasis- Unlabeled uses:Amelioration of

granulocyte suppressionwith fluorouracil; as a

CNS: Headache,drowsiness,peripheralneuropathy, neuritis,paresthesiasDermatologic:Rashesmaculopapular,scaly or exfoliativesometimes fatalGI: Nausea,

vomiting, diarrhea,abdominal pain,gastritis,hepatomegaly,hyperbilirubinemia,cholestatic jaundiceGU: Exacerbation ofgout and renalcalculi, renal failureHematologic:Anemia, leukopenia,agranulocytosis,

thrombocytopenia,aplastic anemia,

Reduce uric acidsynthesis

- Assess for pain- Monitor uric acid

levels q2 wk- Monitor CBC, AST,

BUN, creatininebefore startingtreatment

- Monitor nutritionalstatus: discourageorgan meat,sardines, salmon,

legumes (highpurine),gravies,alcohol

Precautions:- Pregnancy C,

lactation,renal disease,hepaticdisease,children

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mouthwash to preventfluorouracil-inducedstomatitis

Contraindications- allergy to allopurinol,blood dyscrasias,hypersensitivity.

bone marrowdepression