Generic Name/ Trade Name

Classification Inidcation Mechanism of Action Adverse Reaction

Drug Interaction Route/ Frequency/

Dosage

Nursing Considerations

Hemostan antihemorrhagic Effective in promoting hemostasis in traumatic injuries.Preventing hemorrhage after orthopedic surgeries.

Anti-fibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots.

Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue Calf pain, swelling or tenderness Chest pain Confusion Coughing up blood Decreased urination Severe or persistent headache Severe or persistent body malaise Shortness of breath Slurred speech Slurred speech Vision changes

Increased risk of clotting when used w/ estrogen-containing OC.

1 amp q 6H 3x doses

Given on Aug. 26, 2013 (6pm)

Unusual change in bleeding pattern should be immediately reported to the physician. The medication can be taken with or without meals. SwallowTranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing.

Nalbuphine Hydrochloride/

Analgesic used to treat moderate to severe

NUBAIN is a potent analgesic. Its analgesic

Sedation (36%); dizziness, vertigo

CNS depressants, including

1 amp q 4H PRN Advise patient or caregiver that if

Nubain pain and is also used for preoperative and postoperative analgesia

potency is essentially equivalent to that of morphine on a milligram basis. Receptor studies show that NUBAIN binds to mu, kappa, and delta receptors, but not to sigma receptors. NUBAIN is primarily a kappa agonist/partial mu antagonist analgesic.

(5%); headache (3%); agitation, confusion, crying, depression, dysphoria, euphoria, faintness, floating feeling, hallucinations, heaviness feeling, hostility, nervousness, numbness, restlessness, seizures, tingling, unreality, unusual dreams (1% or less).

barbiturate anesthetics

Increased respiratory and CNS depression.

Ordered on Aug. 26, 2013.

Revised on Aug. 27, 2013 with Nubain 10mg/ml 1 amp q4H then revised again on Aug. 30, 2013 with Nubain 1 amp q6H PRN

Discontinued on Sep. 8, 2013

medication needs to be discontinued after prolonged use that it will usually slowly be withdrawn unless safety concerns (eg, rash) require a more rapid withdrawal. Advise patient or caregiver to notify health care provider if any of the following occur: excessive sedation or drowsiness; slow or shallow breathing; low BP; slow heart rate; severe constipation. Instruct patient to get up slowly from lying or sitting position and to avoid sudden position changes to prevent postural hypotension. Advise patient to report dizziness with position changes to health care provider. Caution patient that hot tubs and hot showers or baths may make dizziness worse.

Electrolytic and water balance agent; loop

Treatment of edema associated with CHF,

Rapid-acting potent sulfonamide “loop”

Postural hypotension,

1 amp slow IVTT now

Observe patients receiving parenteral drug

Furosemide/Lasix

diuretic cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia.

diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly defined; decreases renal vascular resistance and may increase renal blood flow.

dizziness with excessive diuresis, acute hypotensive episodes, circulatory collapse, Nausea, vomiting, oral and gastric burning, anorexia, diarrhea, constipation, abdominal cramping, acute pancreatitis, jaundice.

Given on Aug. 26, 2013 (10pm)

carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. Monitor BP during periods of diuresis and through period of dosage adjustment. Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician. Monitor for S&S of hypokalemia . Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions.

Clindamycin/

Clindal

Antibiotics Treatment of serious anaerobic infections especially those caused by Bacteroidesfragilis.

Clindamycin has a bacteriostatic effect. It is a bacterial protein synthesis inhibitor by inhibiting ribosomal

diarrhea which can be severe and persistent, nausea, vomiting, abdominal

Clindamycin has been shown to have neuromuscular blocking

300 mg 1 cap q 8H

Ordered on Aug. 28, 2013

Patients should be counseled that antibacterial drugs including clindamycin should only be used to

As an alternative to penicillin in some severe staphylococcal and streptococcal infections including staphylococcal osteomyelitis.

translocation,in a similar way to macrolides. It does so by binding to the 50S rRNA of the large bacterial ribosome subunit.

cramps and taste abnormality. Severe pseudomembranous colitis

properties that may enhance the action of other neuromuscular blocking agents. It should be used with caution, therefore, in patients receiving such agents.Antagonism has been demonstrated between clindamycin and erythromycin in vitro. Because of possible significance, the 2 drugs should not be administered concurrently.

Discontinued on Sep. 7, 2013

treat bacterial infections. They do not treat viral infections (e.g., the common cold). When clindamycin is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood thatbacteria will develop resistance and will not be treatable by clindamycin or other antibacterial drugs in the future.

Flammazine dressing /Silvadene

topical sulfonamides used in the treatment of dermatological diseases.

SILVADENE Cream 1% (silver sulfadiazine) is a topical antimicrobial drug indicated as an adjunct for the prevention and

Silver sulfadiazine has broad antimicrobial activity. It is bactericidal for many gram-negative and gram-positive bacteria as well as being effective against yeast.

Leukopenia associated with silver sulfadiazine administration is primarily characterized by decreased

proteolytic enzymes are inactivated by silver in cream.

OD

Ordered on Aug. 28, 2013

Discontinued on Sep. 7, 2013

Observe for and report hypersensitivity reaction: Rash, itching, or burning sensation in

treatment of wound sepsis in patients with second- and third-degree burns.

neutrophil count. Maximal white blood cell depression occurs within 2 to 4 days of initiation of therapy. Rebound to normal leukocyte levels follows onset within 2 to 3 days.

unburned areas.

Lab tests: Obtain serum sulfa concentrations, urinalysis, and kidney function tests when drug is applied to extensive areas. Significant quantities of drug may be absorbed. -Observe patient for reactions attributed to sulfonamides.Note: Analgesic may be required. Occasionally, pain is experienced on application; intensity and duration depend on depth of burn.

Continue treatment until satisfactory healing or burn site is ready for grafting, unless adverse reactions occur.

Dulcolax Laxatives Constipation. All conditions which require defecation

Expands intestinal fluid volume by increasing epithelial permeability.

Rarely, abdominal discomfort &

Diuretic &adrenocorticosteroids.

2 supp. Now

Given on Aug.

Evaluate periodically patient's need for continued use of

to be facilitated. diarrhea. 31, 2013 (8pm) drug; bisacodyl usually produces 1 or 2 soft formed stools daily.

Monitor patients receiving concomitant anticoagulants. Indiscriminate use of laxatives results in decreased absorption of vitamin K.

Add high-fiber foods slowly to regular diet to avoid gas and diarrhea. Adequate fluid intake includes at least 6–8 glasses/d.

Cefuroxime/Kefox

Antibiotic, Cephalosporin (second generation)

Dermatologic infections caused by S. aureus, S. pyogenes, E. coli, Klebsiella, Enterobacter ---Perioperative prophylaxis

Cefuroxime binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

nausea, vomiting, diarrhea, GI disturbances; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis. Potentially Fatal: Anaphylaxis, nephrotoxicity, pseudomembranous colitis.

Probenecid increases the concentration of cefuroxime in the blood. Drugs that reduce acidity in the stomach (for example, antacids, H2-blockers, proton pump inhibitors) may reduce absorption of cefuroxime.

750mg IVTT q 8H

Ordered on Sep. 8, 2013

Discontinued on Sep. 28, 2013

Avoid alcohol while taking this drug and for 3 days after because severe reactions often occur.

You may experience these side effects: Stomach upset or diarrhea.

Report severe diarrhea, difficulty breathing, unusual tiredness or fatigue, pain at injection site.

cefdinirAntibiotic Uncomplicated skin

and skin structure infections caused by Staphylococcus aureus, S. pyogenes

Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death.

Headache, dizziness, lethargy, paresthesias Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, membranous colitis, liver toxicity Nephrotoxicity Bone marrow depression

ncreased nephrotoxicity with aminoglycosides Increased bleeding effects if taken with oral anticoagulants Interferes with absorption of cefdinir if taken with antacids containing magnesium or aluminum or with iron supplements; separate by at least 2 hr

1g IVTT q 8H

Ordered on Aug. 28, 2013

Shifted on Sep. 8, 2013 with Cefuroxime/Kefox 750mg IVTT q 8H

Arrange for culture and sensitivity tests of infected area before beginning drug therapy and during therapy if infection does not resolve.

Reconstitute oral suspension by adding 39 mL water to the 60 mL bottle, 65 mL water to the 120 mL bottle; shake well before each use. Store at room temperature. Discard after 10 days.

Give drug with meals; arrange for small, frequent meals if GI complications occur. Separate antacids or iron supplements by 2 hr from the cefdinir dose.

Arrange for treatment of superinfections if they occur.

Metronidazole /Metromed

Antibiotic, Antibacterial, Amebicide, Antiprotozoal

Acute infection with susceptible anaerobic bacteria Acute intestinal amebiasis

Metronidazole is converted to reduction products that interact with DNA to cause destruction of helical DNA structure and strand leading to a protein synthesis inhibition and cell death in susceptible organisms. It is effective against a wide range of organisms including E. histolytica, T. vaginalis, Giardia, anaerobes e.g. Bacterioidessp, Fusobacteriumsp, Clostridium sp, Peptococcussp and Peptostreptococcussp, and moderately active against Gardnerellasp and Campylobacter sp.

GI disturbances e.g. nausea, unpleasant metallic taste, vomiting, diarrhoea or constipation. Furred tongue, glossitis, and stomatitis due to overgrowth of Candida.

500 mg IV q 8H

Ordered on Aug. 28, 2013

Discontinued on Aug. 31, 2013

Resumed on Sep. 15, 2013 with dosage of 500 mg 1 tab q 8H

Discontinued on Sep. 27, 2013

Take full course of drug therapy; take the drug with food if GI upset occurs. Do not drink alcohol (beverages or preparations containing alcohol, cough syrups); severe reactions may occur. Your urine may be a darker color than usual; this is expected. Refrain from sexual intercourse during treatment for trichomoniasis, unless partner wears a condom. Apply the topical preparation by cleansing the area and then rubbing a thin film into the affected area. Avoid contact with the eyes. Cosmetics may be applied to the area after application.

Tetanus Toxoid Anti tetanus Tetanus (tetanus toxoid) Toxoid is indicated for booster injection only for persons 7 years of age or older

produces an immune response that allows the recipient to make their own antibodies.

redness, warmth, edema, induration with or without tenderness as well as urticaria,

The vaccine should be administered subcutaneously in patients on anticoagulan

0.5 ml IM

Given on Aug. 26, 2013 (3pm)

inform the patients about the potential for adverse reactions that have been temporally associated with Tetanus Toxoid (tetanus (tetanus toxoid)

against tetanus (tetanus toxoid).

and rash. Malaise, transient fever, pain, hypotension, nausea and arthralgia may develop in some patients after the injection.

ttherapy.

Immunosuppressive therapies may reduce the response to vaccines

toxoid) administration. inform the parent, guardian, or adult patient of the importance of completing the immunization series, unless a contraindication to further immunization exists.

Parecoxib Analgesics relieve any pain or swelling you may experience as the result of an operation.

helps relieve pain and swelling by stopping the production of the chemicals in the body called prostaglandins that cause inflammation.

Ulcer and gastrointestinal bleeding. Jaundice and abnormal liver function. Heart failure, heart attack, slow heart rate, high/low blood pressure and abnormal heart rhythm. Swelling, rash, itching and difficulty in breathing.

Enhances effects of oral anticoagulants (azapropazone and phenylbutazone); increases plasma concentrations of lithium, methotrexate, and cardiac glycosides; increased risk of nephrotoxicity with ACE inhibitors, ciclosporin, tacrolimus, or diuretics; reduces antihypertensive effects of some antihypertensives (ACE inhibitors, beta blockers,

40 mg IVTT now

Given on Sep. 9, 2013 (12:30am)

*take extra caution to patients with history of dehydration, high blood pressure, liver or kidney disease, gastrointestinal bleeding, ulcer, sugar, any infection, elderly, during pregnancy and breastfeeding. * emphsized that it may cause dizziness or drowsiness, do not drive a car or operate machinery while taking this medication. * note that it should not be used in children.

diuretics)iron, Sorbifer Antianemics Prevention and

treatment of anemias.

is required for production of hemo- globin, which is necessary for oxygen transport to cells. Cyanocobalamin and hydroxocobalaminN (Vitamin B12) and folic acid are water-soluble vitamins that are required for red blood cell pro-Sduction. Darbepoetin and epoetin stimulate production of red blood cells. Nandrolonestimu- lates production of erythropoetin.

N[A Oral iron can decrease the absorption of tetracyclines, fluoroquinolones, or penicillamine. Vita- min E may impair the therapeutic response to iron. Phenytoin and other anticonvulsants may de- crease the absorption of folic acid.

1 tab 2x daily

Ordered on Sep. 3, 2013

Discontinued on Sep. 28, 2013

Encourage patients to comply with diet recommendations of health care professional. Explain that the best source of vitamins and minerals is a well-balanced diet with foods from the four basic food groups..Patients self-medicating with vitamin and mineral supplements should be cautioned not to ex- ceed RDA. The effectiveness of mega doses

Vitamin K Anticoagulant Anticoagulant-inducedprothrombindeficiencycausedbycoumarinorindanedionederivatives;•Prophylaxis andtherapy of hemorrhagicdisease of thenewborn;•hypoprothrombinemia due to anti-bacterial therapy

The action of the aqueous dispersion, when administered intravenously, is generally detectable within an hour or two and hemorrhage is usually controlled within 3 to 6 hours. A normal prothrombin level may often be obtained in 12 to 14 hours.

In the prophylaxis and treatment of hemorrhagic

Deaths have occurred after intravenous and intramuscular administration.

Transient “flushing sensations” and “peculiar” sensations of taste have been observed, as well as rare instances

emporary resistance to prothrombin-depressing anticoagulants may result, especially when larger doses of phytonadione are used. If relatively large doses have been employed, it may be necessary when

1 amp IM

Given on Aug. 26, 2013 (3pm)

IV use: Dilute with 0.9% sodium chloride for injection, D5W, or D5W in 0.9% sodium chloride for injection. Give IV by slow infusion over 2 to 3 hours. Rate shouldn’t exceed 1 mg/minute in adults or 3 mg/m2/minute in children. Effects of IV injection are more rapid but shorter-lived than SC or IM injections.

disease of the newborn, phytonadione has demonstrated a greater margin of safety than that of the water-soluble vitamin K analogues.

of dizziness, rapid and weak pulse, profuse sweating, brief hypotension, dyspnea, and cyanosis.

Pain, swelling, and tenderness at the injection site may occur.

reinstituting anticoagulant therapy to use somewhat larger doses of the prothrombin- depressing anticoagulant, or to use one which acts on a different principle, such as heparin sodium.

Protect parenteral products from light. Wrap infusion container with aluminum foil.

Monitor PT to determine dosage effectiveness as ordered. If severe bleeding occurs, don’t delay other measures, such as fresh frozen plasma or whole blood.

Tetanus Immunoglobulin (human)

Vaccines, Antisera &Immunologicals

Prophylaxis against tetanus following injury in patients whose immunization is incomplete or uncertain; in the regimen of active tetanus, however, evidence of effectiveness is limited.

Passive immunity toward tetanus

Slight soreness at the site of injection and slight temperature elevation may be noted at times. Sensitization to repeated injections of human immunoglobulin is extremely rare.

In the course of routine injections of large numbers of persons with immunoglobulin there have been a

Antibodies in immunoglobulin preparations may interfere with the response to live viral vaccines such as measles, mumps, polio, and rubella. Therefore, use of such vaccines should be deferred until approximately 3 months after Tetanus Immune Globulin (Human) -- BayTet administration.

750 U IM

Given on Aug. 26, 2013 (3pm)

itshould not be given intravenously. Intravenous injection of immunoglobulin intended for intramuscular use can, on occasion, cause a precipitous fall in blood pressure, and a picture not unlike anaphylaxis. Injections should only be made intramuscularly and care should be taken to draw back on the plunger of the syringe before injection in order to be certain that the needle is not in a blood vessel. Intramuscular injections are preferably administered in the

few isolated occurrences of angioneurotic edema, nephroticsyndrome, and anaphylactic shock after injection.

No interactions with other products are known.

anterolateral aspects of the upper thigh and the deltoid muscle of the upper arm. The gluteal region should not be used routinely as an injection site because of the risk of injury to the sciatic nerve. If the gluteal region is used, the central region MUST be avoided; only the upper, outer quadrant should be used

Chloromycetin Chloramphenicolsantibacterial

Used in the systemic treatment of infections.

Bacteriostatic effect against susceptible bacteria; prevents cell replication.

GI intolerance; neurologic reaction; hypersensitivity; superinfection; gray baby syndrome; reversible bone marrow depression (dose-related); aplastic anemia (prolonged therapy). Paroxysmal nocturnal hemoglobinuria, anaphylaxis, Herxheimer reactions,

Retards biotransformation of tolbutamide, phenytoin &dicoumarol. Rifampicin therapy can reduce chloramphenicol conc. Increases tacrolimus serum conc.

500 mg 1 cap q 8H

Ordered on Sep. 3, 2013

Discontinued on Oct. 3, 2013

Culture infection before beginning therapy. Give drug on an empty stomach, 1 h before or 2 h after meals. If severe GI upset occurs, give drug with meals. Do not give this drug IM because it is ineffective. Monitor hematologic data carefully, especially with long-term therapy by any route of administration. Reduce dosage in patients with renal or hepatic disease. Monitor serum levels periodically as indicated in dosage section.

delirium, mental confusion, mild depression, headache, peripheral & optic neuritis, nausea, vomiting, glossitis& stomatitis, diarrhea &enterocolitis.

Polynerv Vitamin B-Complex / with C

Used as dietary supplements. Treatment of vit B deficiencies. Nutritional support in painful neurological manifestations of neuritis & neuropathy eg cervical &shoulder-arm syndrome, lumbago, ischialgia& sciatica.

A coenzyme that stimulates metabolic

function and is needed for cell replication,

hematopoiesis and nucleoprotein and myelin

synthesis.

Vit. B1, B6 and B12 (Polynerv) is valuable in conditions where in the

requirements for B vitamins are increased as

in growth, physiologic stress, decreased

resistance to infection and chronic illnesses and metabolic disorder of the

digestive tract and nervous system.

No known adverse reaction

No drug interaction

500mg BID PO

Ordered on Sep. 27, 2013

Discontinued on Oct. 19, 2013

May be taken with or without food: May be taken w/ meals to reduce GI discomfort.