Pharma

PROMETHAZINE HYDROCHLORIDEPentazine, Phenazine, Phencen, Phenergan, Phenoject-50, Prometh, Prorex, Prothazine, V-GanClassifications: GASTROINTESTINAL AGENT; ANTIEMETIC; ANTIVERTIGO AGENT; PHENOTHIAZINE

IndicationSymptomatic relief of various allergic conditions, to ameliorate and prevent reactions to blood and plasma, and in prophylaxis and treatment of motion sickness, nausea, and vomiting. Preoperative, postoperative, and obstetric sedation and as adjunct to analgesics for control of pain.

ActionsLong-acting derivative of phenothiazine with marked antihistamine activity and prominent sedative, amnesic, antiemetic, and anti-motion-sickness actions. Unlike other phenothiazine derivatives, relatively free of extrapyramidal adverse effects; however, in high doses it carries same potential for toxicity.

ContraindicationsHypersensitivity to phenothiazines; narrow-angle glaucoma; stenosing peptic ulcer, pyloroduodenal obstruction; prostatic hypertrophy; bladder neck obstruction; epilepsy; bone marrow depression; comatose or severely depressed states; pregnancy (category C), lactation, newborn or premature infants, acutely ill or dehydrated children; children <2 y; Reye's syndrome, encephalopathy, hepatic diseases.

Route & Dosage

NauseaAdult: PO/PR/IM/IV 12.5–25 mg q4–6h prnChild: PO/PR/IM/IV 0.25–0.5 mg/kg q4–6h prnAllergiesAdult: PO/PR/IM/IV 12.5 mg q.i.d. or 25 mg h.s.

Child: PO/PR/IM/IV 6.25–12.5 mg q.i.d. or 25 mg h.s.SedationAdult: PO/PR/IM/IV 25–50 mg preoperatively or h.s.Child: PO/PR/IM/IV 12.5–25 mg preoperatively or h.s.

Adverse Effects ( 1%)Body as a Whole: Deep sleep, coma, convulsions, cardiorespiratory symptoms, extrapyramidal reactions, nightmares (in children), CNS stimulation, abnormal movements. Respiratory: Irregular respirations, respiratory depression. CNS: Sedation drowsiness, confusion, dizziness, disturbed coordination, restlessness, tremors. CV: Transient mild hypotension or hypertension. GI: Anorexia, nausea, vomiting, constipation. Hematologic: Leukopenia, agranulocytosis. Special Senses: Blurred vision, dry mouth, nose, or throat. Skin: Photosensitivity. Urogenital: Urinary retention.

NURSING IMPLICATIONSAssessment & Drug Effects Supervise ambulation. Promethazine sometimes produces marked sedation and dizziness. Be aware that antiemetic action may mask symptoms of unrecognized disease and signs of

drug overdosage as well as dizziness, vertigo, or tinnitus associated with toxic doses of aspirin or other ototoxic drugs.

Patients in pain may develop involuntary (athetoid) movements of upper extremities following parenteral administration. These symptoms usually disappear after pain is controlled.

Monitor respiratory function in patients with respiratory problems, particularly children. Drug may suppress cough reflex and cause thickening of bronchial secretions.

Patient & Family Education For motion sickness: Take initial dose 30–60 min before anticipated travel and repeat at 8–12

h intervals if necessary. For duration of journey, repeat dose on arising and again at evening meal.

Do not drive or engage in other potentially hazardous activities requiring mental alertness and normal reaction time until response to drug is known.

Avoid sunlamps or prolonged exposure to sunlight. Use sunscreen lotion during initial drug therapy.

Do not take OTC medications without physician's approval. Avoid alcohol and other CNS depressants. Relieve dry mouth by frequent rinses with water or by increasing noncaloric fluid intake (if

allowed), chewing sugarless gum, or sucking hard candy. If these measures fail, add a saliva substitute (e.g., Moi-Stir, Orex, Xero-Lube).

Do not breast feed while taking this drug.

NALBUPHINE HYDROCHLORIDENubainClassifications: CENTRAL NERVOUS SYSTEM AGENT; ANALGESIC; NARCOTIC (OPIATE) AGONIST-ANTAGONIST

IndicationsSymptomatic relief of moderate to severe pain. Also preoperative sedation analgesia and as a supplement to surgical anesthesia.

ActionsSynthetic narcotic analgesic with agonist and weak antagonist properties. Analgesic potency is about 3 or 4 times greater than that of pentazocine and approximately equal to that produced by equivalent doses of morphine. On a weight basis, produces respiratory depression about equal to that of morphine; however, in contrast to morphine, doses >30 mg produce no further respiratory depression. Antagonistic potency is approximately one fourth that of naloxone and about 10 times greater than that of pentazocine.

ContraindicationsHistory of hypersensitivity to drug. Safety during pregnancy (category C) or lactation is not established. Prolonged use during pregnancy could result in neonatal withdrawal.

Route & Dosage

Moderate to Severe PainAdult: IV/IM/SC 10–20 mg q3–6h prn (max 160 mg/d)Child: IV/IM/SC 0.1–0.15 mg/kg q3–6h prnAdverse Effects ( 1%)

CV: Hypertension, hypotension, bradycardia, tachycardia, flushing. GI: Abdominal cramps, bitter taste, nausea, vomiting, dry mouth. CNS: Sedation, dizziness, nervousness, depression, restlessness, crying, euphoria, dysphoria, distortion of body image, unusual dreams, confusion, hallucinations; numbness and tingling sensations, headache, vertigo. Respiratory: Dyspnea, asthma, respiratory depression.Skin: Pruritus, urticaria, burning sensation, sweaty, clammy skin. Special Senses: Miosis, blurred vision, speech difficulty. Urogenital: Urinary urgency.

NURSING IMPLICATIONSAssessment & Drug Effects

Assess respiratory rate before drug administration. Withhold drug and notify physician if respiratory rate falls below 12.

Watch for allergic response in persons with sulfite sensitivity. Administer with caution to patients with hepatic or renal impairment. Monitor ambulatory patients; nalbuphine may produce drowsiness. Watch for respiratory depression of newborn if drug is used during labor and

delivery. Avoid abrupt termination of nalbuphine following prolonged use, which may

result in symptoms similar to narcotic withdrawal: nausea, vomiting, abdominal cramps, lacrimation, nasal congestion, piloerection, fever, restlessness, anxiety.

Patient & Family Education Do not drive or engage in potentially hazardous activities until response to drug is known. Avoid alcohol and other CNS depressants. Do not breast feed while taking this drug without consulting physician.

MELOXICAM(mel-ox'-i-cam)MobicClassifications: CENTRAL NERVOUS SYSTEM AGENT (CNS); ANALGESIC; NONSTEROIDAL ANTI-INFLAMMATORY DRUG (NSAID)

ActionsIs a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory, analgesic, and antipyretic activities. The mechanism of action, like other NSAIDs, may be related to prostaglandin synthetase (cyclooxygenase) inhibition.

IndicationsRelief of the signs and symptoms of osteoarthritis, rheumatoid arthritis.

ContraindicationsHypersensitivity to meloxicam; rhinitis, urticaria/angioedema, asthma; allergic reactions to aspirin or other antiinflammatory agents; NSAID hypersensitivity, severe renal or hepatic disease; salicylate hypersensitivity, pregnancy [(category C) first and second trimester, (category D) third trimester)], lactation; bleeding.

Route & DosageOsteoarthritisAdult: PO 7.5–15 mg once daily

Rheumatoid ArthritisAdult: PO 15 mg once daily

Adverse Effects ( 1%)Body as a Whole: Edema, fall, flu-like syndrome, pain. GI: Abdominal pain, diarrhea, dyspepsia, flatulence, nausea, constipation, ulceration, GI bleed. Hematologic: Anemia. Musculoskeletal:Arthralgia. CNS: Dizziness, headache, insomnia. Respiratory: Pharyngitis, upper respiratory tract infection, cough. Skin: Rash, pruritus. Urogenital: Micturition frequency, urinary tract infection.


Monitor for and immediately report S&S of GI ulceration or bleeding, including black, tarry stool, abdominal or stomach pain; hepatotoxicity, including fatigue, lethargy, pruritus, jaundice, flu-like symptoms; skin rash; weight gain and edema.

Withhold drug and notify physician if hepatotoxicity or GI bleeding is suspected. Monitor carefully patients with a history of CHF, HTN, or edema for fluid retention. Monitor diabetics using sulfonylureas for hypoglycemia. Lab tests: Hgb & Hct, CBC with differential, liver function tests, serum electrolytes, BUN,

and creatinine within 3 mo of initiating therapy and every 6–12 mo thereafter; with high-risk patients (e.g., >60 yr, history of peptic ulcer disease, prolonged or high-dose NSAID

therapy, concurrent use of corticosteroids or anticoagulants) monitor within first 3–4 wk and every 3–6 mo thereafter.

Coadministered drugs: With warfarin, closely monitor INR when meloxicam is initiated or dose changed; monitor for lithium toxicity, especially during addition, withdrawal, or change in dose of meloxicam.

Patient & Family Education Report any of the following to the physician immediately: nausea, black tarry stool,

abdominal or stomach pain, unexplained fatigue or lethargy, itching, jaundice, flu-like symptoms, skin rash, weight gain, or edema.

Minimize alcohol intake and use of tobacco. Discontinue drug if hepatotoxicity or GI bleeding is suspected. Note that GI bleeding may occur without forewarning and is more likely in older adults, in those with a history of ulcers or GI bleeding, and with alcohol consumption and cigarette smoking.

Do not take aspirin or other NSAIDs while on this medication. Do not breast feed while taking this drug.

CEFUROXIME SODIUMKefurox, ZinacefClassifications: ANTIINFECTIVE; ANTIBIOTIC; SECOND-GENERATION CEPHALOSPORIN

IndicationsInfections caused by susceptible organisms in the lower respiratory tract, urinary tract, skin, and skin structures; also used for treatment of meningitis, gonorrhea, and otitis media and for perioperative prophylaxis (e.g., open-heart surgery), early Lyme disease.

ActionsSemisynthetic second-generation cephalosporin antibiotic with structure similar to that of the penicillins. Resistance against beta-lactamase-producing strains exceeds that of first generation cephalosporins. Antimicrobial spectrum of activity resembles that of cefonicid. Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing the bacterium. Partial cross-allergenicity between other beta-lactam antibiotics and cephalosporins has been reported.

ContraindicationsHypersensitivity to cephalosporins and related antibiotics; pregnancy (category B), lactation.

Route & DosageModerate to Severe InfectionsAdult: PO 250–500 mg q12h. IV/IM 750 mg–1.5 g q6–8h

Child (3 mo–12 y): PO 10–15 mg/kg (125–250 mg) q12h. IV/IM 75–100 mg/kg/d divided q8h (max 6 g/d)Neonate: IM/IV 20–100 mg/kg/d divided q12h

Bacterial MeningitisAdult: IV/IM 3 g q8hChild: IV/IM 200–240 mg/kg/d divided q6–8h; reduced to 100 mg/kg/d upon improvement

Surgical ProphylaxisAdult: IV/IM 1.5 g 30–60 min before surgery, then 750 mg q8h for 24 hChild: IV/IM Same as for adult

Adverse Effects ( 1%)Body as a Whole: Thrombophlebitis (IV site); pain, burning, cellulitis (IM site); superinfections, positive Coombs' test. GI: Diarrhea, nausea, antibiotic-associated colitis. Skin: Rash, pruritus, urticaria.Urogenital: Increased serum creatinine and BUN, decreased creatinine clearance.


Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated.

Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated. Therapy may be instituted pending test results. Monitor periodically BUN and creatinine clearance.

Inspect IM and IV injection sites frequently for signs of phlebitis. Report onset of loose stools or diarrhea. Although pseudomembranous colitis (see Signs &

Symptoms, Appendix F) rarely occurs, this potentially life-threatening complication should be ruled out as the cause of diarrhea during and after antibiotic therapy.

Monitor for manifestations of hypersensitivity (see Appendix F). Discontinue drug and report their appearance promptly.

Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes.

Patient & Family Education Report loose stools or diarrhea promptly. Report any signs or symptoms of hypersensitivity (see Appendix F). Do not breast feed while taking this drug.

FERROUS SULFATE Feosol, Fer-In-Sol, Fer-Iron, Fero-Gradumet, Ferospace, Ferralyn, Ferra-TD, Fesofor, Hematinic, Mol-Iron, Slow-FeClassifications: BLOODS FORMERS, COAGULATORS, AND ANTICOAGULANTS; IRON PREPARATION

IndicationsTo correct simple iron deficiency and to treat iron deficiency (microcytic, hypochromic) anemias. Also may be used prophylactically during periods of increased iron needs, as in infancy, childhood, and pregnancy.

ActionsFerrous sulfate: Standard iron preparation against which other oral iron preparations are usually measured. Corrects erythropoietic abnormalities induced by iron deficiency but does not stimulate erythropoiesis. May reverse gastric, esophageal, and other tissue changes caused by lack of iron.

ContraindicationsPeptic ulcer, regional enteritis, ulcerative colitis; hemolytic anemias (in absence of iron deficiency), hemochromatosis, hemosiderosis, patients receiving repeated transfusions, pyridoxine-responsive anemia; cirrhosis of liver.

Route & Dosage

Iron DeficiencyAdult: PO Sulfate (30% elemental iron) 750–1500 mg/d in 1–3 divided doses; Fumarate (33% elemental iron) 200 mg t.i.d. or q.i.d.; Gluconate (12% elemental iron) 325–600 mg q.i.d., may be gradually increased to 650 mg q.i.d. as needed and toleratedChild: PO Sulfate (30% elemental iron) <6 y, 75–225 mg/d in divided doses; 6–12 y, 600 mg/d in divided doses; Fumarate (33% elemental iron) 3 mg/kg t.i.d.; Gluconate (12% elemental iron) <6 y, 100–300 mg/d in divided doses; 6–12 y, 100–300 mg t.i.d.

Iron SupplementAdult: PO Sulfate Pregnancy, 300–600 mg/d in divided doses; Fumarate 200 mg once/d; Gluconate 325–600 mg once/dChild: PO Fumarate 3 mg/kg once/d; Gluconate <6 y, 100–300 mg/d in divided doses; 6–12 y, 100–300 mg once/dInfant: PO Fumarate Low birth weight, 2 mg/kg/d up to 15 mg/d; 3 y, 1 mg/kg/d (max: 15 mg/d)

Adverse Effects ( 1%)GI: Nausea, heartburn, anorexia, constipation, diarrhea, epigastric pain, abdominal distress, black stools. Special Senses: Yellow-brown discoloration of eyes and teeth (liquid forms.) Large Chronic Doses in Infants Rickets (due to interference with phosphorus absorption). Massive Overdosage Lethargy, drowsiness, nausea, vomiting, abdominal pain,

diarrhea, local corrosion of stomach and small intestines, pallor or cyanosis, metabolic acidosis, shock, cardiovascular collapse, convulsions, liver necrosis, coma, renal failure, death.


Lab tests: Monitor Hgb and reticulocyte values during therapy. Investigate the absence of satisfactory response after 3 wk of drug treatment.

Continue iron therapy for 2–3 mo after the hemoglobin level has returned to normal (roughly twice the period required to normalize hemoglobin concentration).

Monitor bowel movements as constipation is a common adverse effect.

Patient & Family Education Note: Ascorbic acid increases absorption of iron. Consuming citrus fruit or tomato juice

with iron preparation (except the elixir) may increase its absorption. Be aware that milk, eggs, or caffeine beverages when taken with the iron preparation may

inhibit absorption. Be aware that iron preparations cause dark green or black stools. Report constipation or diarrhea to physician; symptoms may be relieved by adjustments in

dosage or diet or by change to another iron preparation. Do not breast feed while taking this drug without consulting physician.

RANITIDINE HYDROCHLORIDEZantac, Zantac EFFERdose, Zantac GELdose, Zantac-75Classifications: GASTROINTESTINAL AGENT; ANTISECRETORY (H2-RECEPTOR ANTAGONIST)

IndicationsShort-term treatment of active duodenal ulcer; maintenance therapy for duodenal ulcer patient after healing of acute ulcer; treatment of gastroesophageal reflux disease; short-term treatment of active, benign gastric ulcer; treatment of pathologic GI hypersecretory conditions (e.g., Zollinger-Ellison syndrome, systemic mastocytosis, and postoperative hypersecretion); heartburn.

ActionsPotent anti-ulcer drug that competitively and reversibly inhibits histamine action at H2-receptor sites on parietal cells, thus blocking gastric acid secretion. Indirectly reduces pepsin secretion but appears to have minimal effect on fasting and postprandial serum gastrin concentrations or secretion of gastric intrinsic factor or mucus.

ContraindicationsHypersensitivity to ranitidine; acute porphyria; OTC administration in children <12 y.

Route & Dosage

Duodenal Ulcer, Gastric Ulcer, Gastroesophageal RefluxAdult: PO 150 mg b.i.d. or 300 mg h.s. IV 50 mg q6–8h; 150–300 mg/24 h by

continuous infusionChild: PO 4–5 mg/kg/d divided q8–12h (max: 6 mg/kg/d or 300 mg/d) IM/IV 2–4 mg/kg/d divided q6–8h; 0.1–0.125 mg/kg/h by continuous infusionInfant: PO <2 wk, 2 mg/kg/d divided q12h IV 1.5 mg/kg/d divided q12h or 0.04 mg/kg/h by continuous infusion

Duodenal Ulcer, Maintenance TherapyAdult: PO 150 mg h.s.

Pathologic Hypersecretory ConditionsAdult: PO 150 mg b.i.d. up to 6.3 g/d IV 50 mg q6–8h

HeartburnAdult: PO 75–150 mg b.i.d.

Adverse Effects ( 1%)CNS: Headache, malaise, dizziness, somnolence, insomnia, vertigo, mental confusion, agitation, depression, hallucinations in older adults. CV: Bradycardia (with rapid IV push). GI: Constipation, nausea, abdominal pain, diarrhea. Skin: Rash. Hematologic: Reversible decrease in WBC count, thrombocytopenia. Body as a Whole: Hypersensitivity reactions, anaphylaxis (rare).


Potential toxicity results from decreased clearance (elimination) and therefore prolonged action; greatest in the older adult patients or those with hepatic or renal dysfunction.

Lab tests: Periodic liver functions. Monitor creatinine clearance if renal dysfunction is present or suspected. When clearance is <50 mL/min, manufacturer recommends reduction of the dose to 150 mg once q24h with cautious and gradual reduction of the interval to q12h or less, if necessary.

Be alert for early signs of hepatotoxicity (though low and thought to be a hypersensitivity reaction): jaundice (dark urine, pruritus, yellow sclera and skin), elevated transaminases (especially ALT) and LDH.

Long-term therapy may lead to vitamin B12 deficiency.

Patient & Family Education

Note: Long duration of action provides ulcer pain relief that is maintained through the night as well as the day.

Be aware that even if symptomatic relief is provided by ranitidine, this should not be interpreted as absence of gastric malignancy. Follow-up examinations will be scheduled after therapy is discontinued.

Adhere to scheduled periodic laboratory checkups during ranitidine treatment. Do not supplement therapy with OTC remedies for gastric distress or pain without

physician's advice (e.g., Mylanta II reduces ranitidine absorption). Do not smoke; research shows smoking decreases ranitidine efficacy and adversely affects

ulcer healing. Do not breast feed while taking this drug without consulting physician.

METRONIDAZOLE Flagyl, Flagyl ER, Flagyl IV RTU, Flagyl 375, Metizol, Metric 21, Metro I.V., MetroGel, MetroGel Vaginal, MetroLotion, Noritate, ProtostatClassifications: ANTIINFECTIVE; ANTITRICHOMONAL; AMEBICIDE; ANTIBIOTIC

IndicationsAsymptomatic and symptomatic trichomoniasis in females and males; acute intestinal amebiasis and amebic liver abscess; preoperative prophylaxis in colorectal surgery, elective hysterectomy or vaginal repair, and emergency appendectomy. IV metronidazole is used for the treatment of serious infections caused by susceptible anaerobic bacteria in intraabdominal infections, skin infections, gynecologic infections, septicemia, and for both pre- and postoperative prophylaxis, bacterial vaginosis. Topical: Rosacea.

ActionsSynthetic compound with direct trichomonacidal and amebicidal activity as well as antibacterial activity against anaerobic bacteria and some gram-negative bacteria.

Route & DosageTrichomoniasis, Giardiasis, GardnerellaAdult: PO 2 g once or 250 mg t.i.d.; 375 mg b.i.d. or 500 mg b.i.d. for 7 d Vaginal Apply once or twice daily times 5 dChild: PO 15 mg/kg/d in 3 divided doses for 7–10 dInfant: PO 10–30 mg/kg/d for 5–8 d

AmebiasisAdult: PO 500–750 mg t.i.d.Child: PO 35–50 mg/kg/d in 3 divided dosesAnaerobic InfectionsAdult: PO 7.5 mg/kg q6h (max: 4 g/d) IV Loading Dose 15 mg/kg IV Maintenance Dose 7.5 mg/kg q6h (max: 4 g/d)Child: PO/IV 30 mg/kg/d divided q6h (max: 4 g/d)Neonate: PO/IV 7.5–15 mg/kg/d divided q12–48hPseudomembranous ColitisAdult: PO 250–500 mg t.i.d. IV 250–500 mg t.i.d. or q.i.d.Child: PO 30 mg/kg/d divided q6h times 7 dBacterial VaginosisAdult: PO (Flagyl ER) 750 mg q.d. times 7 d

Adverse Effects ( 1%)Body as a Whole: hypersensitivity (rash, urticaria, pruritus, flushing), fever, fleeting joint pains, overgrowth of Candida. CNS: Vertigo, headache, ataxia, confusion, irritability, depression, restlessness, weakness, fatigue, drowsiness, insomnia, paresthesias, sensory neuropathy (rare). GI: Nausea, vomiting, anorexia, epigastric distress, abdominal cramps, diarrhea, constipation, dry mouth, metallic or bitter taste, proctitis. Urogenital: Polyuria, dysuria, pyuria, incontinence, cystitis, decreased libido, dyspareunia, dryness of vagina and

vulva, sense of pelvic pressure. Special Senses: Nasal congestion. CV:ECG changes (flattening of T wave).


Discontinue therapy immediately if symptoms of CNS toxicity (see Appendix F) develop. Monitor especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities).

Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a second course is necessary.

Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of CHF.

Monitor patients on lithium for elevated lithium levels. Report appearance of candidiasis or its becoming more prominent with therapy to physician

promptly. Repeat feces examinations, usually up to 3 mo, to ensure that amebae have been

eliminated.

Patient & Family Education Adhere closely to the established regimen without schedule interruption or changing the

dose. Refrain from intercourse during therapy for trichomoniasis unless male partner wears a

condom to prevent reinfection. Have sexual partners receive concurrent treatment. Asymptomatic trichomoniasis in the

male is a frequent source of reinfection of the female.

Do not drink alcohol during therapy; may induce a disulfiram-type reaction (see Appendix F). Avoid alcohol or alcohol-containing medications for at least 48 h after treatment is completed.

Urine may appear dark or reddish brown (especially with higher than recommended doses). This appears to have no clinical significance.

Report symptoms of candidal overgrowth: Furry tongue, color changes of tongue, glossitis, stomatitis; vaginitis, curd-like, milky vaginal discharge; proctitis. Treatment with a candidacidal agent may be indicated.

Do not breast feed while taking this drug.

BISACODYL (bis-a-koe'dill) Bisacolax, Dacodyl, Deficol, Dulcolax, TheralaxClassifications: GASTROINTESTINAL AGENT; STIMULANT LAXATIVE

IndicationsTemporary relief of acute constipation and for evacuation of colon before surgery, proctoscopic, sigmoidoscopic, and radiologic examinations. Also used to cleanse colon before delivery and to relieve constipation in patients with spinal cord damage.

ActionsExpands intestinal fluid volume by increasing epithelial permeability.

ContraindicationsAcute surgical abdomen, nausea, vomiting, abdominal cramps, intestinal obstruction, fecal impaction; use of rectal suppository in presence of anal or rectal fissures, ulcerated hemorrhoids, proctitis.

Route & Dosage

LaxativeAdult: PO 5–15 mg prn (max: 30 mg for special procedures) PR 10 mg prnChild: PO 6 y, 5–10 mg prn PR 2 y, 10 mg; <2 y, 5 mgAdministration

Adverse Effects ( 1%)Systemic effects not reported. Mild cramping, nausea, diarrhea, fluid and electrolyte disturbances (especially potassium and calcium).


Evaluate periodically patient's need for continued use of 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.

Patient & Family Education Add high-fiber foods slowly to regular diet to avoid gas and diarrhea. Adequate fluid intake

includes at least 6–8 glasses/d. Do not breast feed while taking this drug without consulting physician.

MUPIROCINBactroban, Bactroban NasalClassifications: ANTIINFECTIVE; PSEUDOMONIC ACID ANTIBIOTICPregnancy Category: B

InidicationsImpetigo due to Staphylococcus aureus, beta-hemolytic Streptococci, and Streptococcus pyogenes; nasal carriage of S. aureus.

ActionsTopical antibacterial produced by fermentation of Pseudomonas fluorescens.

ContraindicationsHypersensitivity to any of its components and for ophthalmic use.

Route & DosageImpetigoAdult/Child: Topical Apply to affected area t.i.d., if no response in 3–5 d, reevaluate (usually continue for 1–2 wk)

Elimination of Staphylococcal Nasal CarriageChild: Intranasal Apply intranasally b.i.d. to q.i.d. for 5–14 dAdministration

Adverse Effects ( 1%)Skin: Burning, stinging, pain, pruritus, rash, erythema, dry skin, tenderness, swelling. Special Senses: Intranasal, local stinging, soreness, dry skin, pruritus.


Watch for signs and symptoms of superinfection (see Appendix F). Prolonged or repeated therapy may result in superinfection by nonsusceptible organisms.

Reevaluate drug use if patient does not show clinical response within 3–5 d. Discontinue the drug and notify physician if signs of contact dermatitis develop or if

exudate production increases.

Patient & Family Education Discontinue drug and contact physician if a sensitivity reaction or chemical irritation

occurs (e.g., increased redness, itching, burning). Do not breast feed while taking this drug without consulting physician.

TRANEXAMIC ACIDCyclotrax, Dostan, Fibrinon, Hemoclot, Hemostan, Hemostop, Hemotrex, Micranex, Pantrex, Trenaxin Classifications: HAEMOSTATICS Pregnancy Category: B

Inidications/DosagePO Short-term management of haemorrhage 1-1.5 g 2-4 times/day. Long-term management of hereditary angioedema 1-1.5 g 2-3 times/day. IV Short-term management of haemorrhage 0.5-1 g 3 times/day

ActionsTranexamic acid is an antifibrinolytic agent that competitively inhibits breakdown of fibrin clots. It blocks binding of plasminogen and plasmin to fibrin, thereby preventing haemostatic plug dissolution.

ContraindicationsSevere renal failure, active intravascular clotting, thromboembolic disease, colour vision disorders, subarachnoid bleeding.

Adverse Effects

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Diarrhoea, nausea, vomiting, disturbances in colour vision, giddiness, hypotension (after rapid IV inj), thromboembolic events.

NURSING IMPLICATIONS Prepare and administer medication. Monitor for occurrence of adverse effects.

TETANUS IMMUNE GLUBULINBayTetClassifications: IMMUNE SERUMPregnancy Category: C

Inidications/DosageTetanus exposure: adults and children age 7 and older: 250 units IMTetanus: adults and children: single doses of 3,000 to 6,000 units IM

ActionsProvides passive immunity to tetanus.

ContraindicationsContraindicated in patients with thrombocytopenia or coagulation disorders.

Adverse Effects GU: slinght fever, nephritic syndrome; Other: erythema, pain, stiffness at injection site; hypersensitivity reactions

NURSING IMPLICATIONS Be alert for adverse reactions and drug interactions. Assess patient’s and family’s knowledge of drug therapy. Have epinephrine available to treat hypersensitivity reactions.

Don’t confuse drug for tetanus toxiod.

Patient & Family Education Warn patient of pain and tenderness at injection site.

TETANUS TOXOID VACCINE Tetanus Toxoid, Tetanus Toxoid adsorbedClassifications: VACCINEPregnancy Category: C

Inidications/DosagePrimary Prevention to prevent tetanus: ages ≥ 7 y.o.: 0.5 ml IM. 4-8 weeks apart for two doses; then give third dose 6-12 monthsBooster dose to prevent tetanus: ages ≥ 7 y.o.: 0.5 ml at 10 yr intervalsPostexposure prevention of tetanus

ActionsPromotes immunity to tetanus by inducing antitoxin production.

ContraindicationsHypersensitivity. Febrile illness, other acute infections. Postpone vaccination in patient w/ low immune response.

Adverse Effects Local reactions eg redness, swelling & pain w/ local lymphadenopathy. Occasionally granuloma. Local & systemic hypersensitivity reactions. GI disorders eg vomiting, diarrhoea & loss of appetite. Rarely peripheral & CNS disorders, including Guillain-Barre syndrome. Thrombocytopenia.

NURSING IMPLICATIONS Obtain history of allergies and reaction to immunization Determine date of last tetanus immunization Keep epinephrine available to treat anaphylaxis Don’t confuse drug with tetanus immune globulin

Patient & Family Education Advise patient to avoid hot and cold compresses at injection site; this may increase

severity of local reaction Instruct patient to report persistent or severe adverse reactions Tell patient that nodule at injection site may b present for a few weeks

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