Drug’s Name Classification Indication Action Contraindications/ Precautions

Adverse Reaction Patient/ Family Teaching

RANITIDINE(Zantac)

Histamine₂ Blocker

Treatment and prevention of heartburn, acid indigestion, and sour stomach.

Potent 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.

Contraindicated with allergy to ranitidine, lactation.Use cautiously with impaired renal or hepatic function and pregnancy.

•CNS:Confusion, dizziness, drowsiness, hallucinations, headache•CV:Arrhythmias•GI:Altered taste, black tongue, constipation, dark stools, diarrhea, nausea•GU:Decreased sperm count, impotence•HEMATOLOGY:Agranulocytosis, neutropenia, thrombocytopenia•MISC:Hypersensitivity reactions, vasculitis

• Take drug with meals and at bedtime. Therapy may continue for 4-6 weeks or longer.• If you are also using an antacid, take it exactly as prescribed, being careful of the times of administration.• Have regular medical follow –up care to evaluate your response.• Report sore throat, fever, unusual bruising or bleeding, tarry stools, severe headache, muscle or joint pain.

Drug’s Name Classification Indication Action Contraindications/ Precautions

Adverse Reaction Patient/ Family Teaching

Phospho-soda (sodium biphosphate and sodium phosphate)

Laxatives, Purgatives

Relief of occasional constipation. For bowel cleansing prior to medical procedures e.g. surgery, x-ray or endoscopic exam.

Saline laxative; osmotically mediated water retention which stimulates peristalsis.

Impaired renal function, preexisting electrolyte imbalances, and debilitated patients. Rectal bleeding or no bowel movement after use.

Transient hyperphosphatemia.

Should be taken on an empty stomach (Take on an empty stomach 1 hr before or 2 hr after meals. Dilute recommended dose w/ ½ glass of water, drink & follow w/ 1 full glass of water.).

Drug’s Name Classification Indication Action Contraindications/ Precautions

Adverse Reaction

Patient/ Family Teaching

Darcef (cefuroxime)

Second-generation cephalosporins

Uncomplicated urinary tract infections

Respiratory tract infections

Uncomplicated gonorrhoea

Otitis media Meningitis Renal

impairment

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.Absorption: Absorbed from the GI tract with peak plasma concentrations after 2-3 hr (oral); may be enhanced by the presence of food.Distribution: Pleural and synovial fluid, sputum, bone and aqueous fluids; CSF (therapeutic concentrations). Crosses the placenta and enters breast milk. Protein-binding: Up to 50%.Metabolism: Rapidly hydrolysed (intestinal mucosa and blood).

Severe renal impairment; pregnancy, lactation; hypersensitivity to penicillins.

Hypersensitivity to cephalosporins.

Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhea, GI disturbances; erythema multiform, Stevens-Johnson syndrome, epidermal necrolysis.Potentially Fatal: Anaphylaxis, nephrotoxicity, pseudomembranous colitis.

Advise patient to immediately report rash or bleeding tendency.• Instruct patient to take drug with food every 12 hours as prescribed.• Teach patient how to recognize signs and symptoms of super infection. Instruct him to report these right away.• Advise patient to report CNS changes.• As appropriate, review all other significant and life-threatening

Excretion: Via the urine by glomerular filtration and renal tubular secretion (as unchanged); via bile (small amounts); 70 min (elimination half-life); prolonged in neonates and renal impairment.

adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

Drug’s Name

Classification Indication Action Contraindications/ Precautions

Adverse Reaction Patient/ Family Teaching

Hemostan Antihemophilic agent

Anti-hemorrhagic and anti-fibrinolytic for effective hemostasis in various surgical and clinical cases.

Forms a reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis

Forms a reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis,

Not advisable to use for prolonged periods in patients predisposed to thrombosis.

Not recommended for prophylaxis during pregnancy and before delivery.

Opthalmic exam before and during therapy required if patient is treated beyond several days;

caution in patients with cardiovascular, renal and cerebrovascular disease.

Gastrointestinal disorders:Nausea, Vomiting

Central Nervous System:Anorexia, Headache, impaired renal insufficiency, hypotension occurs when iv injection is too rapid

Dosage modification required in patients with renal impairment.

Watch out for any signs of bleeding.

Drug’s Name Classification Indication Action Contraindications/ Precautions

Adverse Reaction

Patient/ Family Teaching

Furosemide Electrolytic and water balance agent; loop diuretic.

For the treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome.

Also for the treatment of hypertension alone or in combination with other antihypertensive agents.

Furosemide inhibits reabsorption of Na and chloride mainly in the medullary portion of the ascending Loop of Henle.

Excretion of potassium and ammonia is also increased while uric acid excretion is reduced. It increases plasma-renin levels and secondary hyperaldosteronism may result.

Furosemide reduces BP

Severe sodium and water depletion, hypersensitivity to sulphonamides and furosemide, hypokalaemia, hyponatraemia, precomatose states associated with liver cirrhosis, anuria or renal failure. Addison's disease.

Monitor fluid and electrolyte balance and renal function.

It also lowers serum levels of

Rashes, photosensitivity, nausea, diarrhoea, blurred vision, dizziness, headache, hypotension.

Hypokalaemia and magnesium depletion can cause cardiac arrhythmias.

Fluid and electrolyte

Instruct patient to take furosemide as directed. Take missed doses as soon as possible; do not double doses

Caution patient to change positions slowly to minimize orthostatic hypotension.

Instruct patient to consult health care professional regarding a diet high in potassium

Advise patient to contact health care professional immediately if muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs.

Emphasize the importance of routine follow-up examinations

Advise patients on antihypertensive

in hypertensives as well as in normotensives.

It also reduces pulmonary oedema before diuresis has set in.

calcium and magnesium, thus serum levels should be monitored. Pregnancy and lactation.

imbalance.

regimen to continue taking medication even if feeling better. Furosemide controls but does not cure hypertension.

Drug’s Name

Classification

Indication Action Contraindications/ Precautions

Adverse Reaction Patient/ Family Teaching

Metronidazole

Antimicrobial

Treatment of serious abdominal infections due to susceptible anaerobic bacteria.

Treatment of protozoal infections. e.g. Amebiasis, giardiasis, trichomoniasis

selectively absorbed by anaerobic bacteria and sensitive protozoa. Once taken up by anaerobes, it is non-enzymatically reduced by reacting with reduced ferredoxin, which is generated by pyruvate oxido-reductase.

History of hypersensitivity to metronidazole or other nitroimidazole derivatives.

Patients with Central Nervous System diseases; discontinue iv therapy if abnormal neurologic symptoms occur. History of seizure disorder.

Evidence or a history of blood dyscrasias; perform total and differential leukocyte counts

GIdisturbances e.g. Nausea, unpleasant metallic taste, vomiting, diarrhoea or constipation. Furred tongue, glossitis, and stomatitis due to overgrowth of candida. Rarely, antibiotic-associated colitis.

Weakness, dizziness, ataxia, headache, drowsiness, insomnia, changes in mood or mental state. Numbness or tingling in the extremities, epileptiform seizures (high doses or prolonged

Advise patient to take drug with food if it causes GI upset. However, instruct him to take extended-release tablets 1 hour before or 2 hours after meals.

Advise patient to report fever, sore

before and after treatment.

Severe hepatic impairment; monitor plasma levels.

Prolonged use may result in fungal or bacterial superinfection.

treatment). Transient

leucopenia and thrombocytopenia. Hypersensitivity reactions.

Urethral discomfort and darkening of urine.

Raised liver enzyme values, cholestatic hepatitis, and jaundice. Thrombophlebitis.

throat, bleeding, or bruising.

Inform patient that drug may cause metallic taste and may discolor urine to brownish-red.

Drug’s Name

Classification Indication Action Contraindications/ Precautions

Adverse Reaction

Patient/ Family Teaching

Salbutamol Bronchodilator (therapeutic); adrenergics (pharmacologic)

For symptomatic relief and prevention of bronchospasm due to bronchial asthma, chronic bronchitis, and other chronic bronchopulmonary disorders such as COPD.

It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles. The relief from nasal congestion and bronchospasm is made possible by the following mechanism that takes place when Salbutamol is administered.

• Hypersensitivity to adrenergic amines

• Hypersensitivity to fluorocarbons

• Cardiac disease including coronary insufficiency, a history of stroke, coronary artery disease and cardiac arrhythmias

• Hypertension• Hyperthyroidism• Diabetes• Glaucoma• Geriatric patients –

older individuals are at higher risk for adverse reactions and may require lower dosage

• Pregnancy especially near term

• Lactation• Children less than 2

years of age because safety of its use has not been established

• Excess inhaler use which may lead to tolerance and paradoxical bronchospasm

•Nervousness•Restlessness•Tremor•Headache•Insomnia•Chest pain•Palpitations•Angina•Arrhythmias•Hypertension•Nausea and vomiting

•Hyperglycemia•Hypokalemia

Tell patient to swallow extended-release tablets whole and not to mix them with food.

Teach patient signs and symptoms of hypersensitivity reaction and paradoxical bronchospasm. Tell him to stop taking drug immediately and contact prescriber if these occur.

Instruct patient to notify prescriber immediately if prescribed dosage fails to provide usual relief, because this may indicate seriously worsening asthma.

Advise patient

to limit intake of caffeine containing foods and beverages and to avoid herbs unless prescriber approves.

Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

Advise patient to establish effective bedtime routine and to take drug well before bedtime to minimize insomnia.

As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to

the drugs, foods, and herbs mentioned above.

Drug’s Name

Classification

Indication Action Contraindications/ Precautions

Adverse Reaction Patient/ Family Teaching

Ketorolac(Toradol)

Nonsteroidal anti-inflammatory agents, nonopioid analagesics

Short term management of pain (not to exceed 5 days total for all routes combined)

Inhibits prostaglandin synthesis, producing peripherally mediated analgesia.

Also have antipyretic and anti-inflammatory properties.

Therapeutic effect: Decreased pain.

HypersensitivityCross-sensitivity with other Non-Steroidal Anti-Inflammatory Drugs may exist¨Pre- or perioperative use

Known alcohol intolerance

Use cautiously in:1. History of

GastroIntestinal bleeding

2. Renal impairment (dosage reduction may be required)

3. Cardiovascular disease

CENTRAL NERVOUS SYSTEM:drowsiness, abnormal thinking, dizziness, euphoria, headache

RESPIRATORY:asthma, dyspnea

CARDIOVASCULAR:edema, pallor, vasodilation

GASTROINTESTINAL:GI Bleeding, abnormal taste, diarrhea, dry mouth, dyspepsia, GI pain, nausea

GENITOURINARY:oliguria, renal toxicity, urinary frequency

DERMATOLOGY:pruritis, purpura, sweating, urticaria

HEMATOLOGY:prolonged bleeding time

LOCAL:injection site pain

NEURO:paresthesia

MISCELLANEOUS:allergic reaction, anaphylaxis

Instruct patient on how and when to ask for pain medicatio.

Take missed doses as soon as remembered if not almost time for next dose. Do not double doses. Do not take more than prescribed or for longer than 5 days.

May cause drowsiness or dizziness.

Advise patient to avoid driving or

other activities requiring alertness until response to the medication is known.

Drug’s Name Classification Indication Action Contraindications/ Precautions

Adverse Reaction

Patient/ Family Teaching

Tramadol Analgesics Moderate to moderately severe pain

Physiologic Mechanism• Decreased pain.Pharmacologic Mechanism• Binds to mu-opioid receptors.• Inhibits reuptake of serotonin and norepinephrine in the CNS

abrupt discontinuation, ethanol intoxication, opiate agonist hypersensitivity, breast-feeding, children, driving or operating machinery, elderly, GI disease, head trauma, hepatic disease, increased intracranial pressure, labor, pregnancy, renal impairment, respiratory depression, seizure disorder, substance abuse

Dizziness or vertigo, Nausea and Vomiting, Constipation, Headache, Somnolence, Pruritus, CNS Stimulation, Asthenia, Diaphoresis, Dyspepsia, Dry mouth, Diarrhea, Malaise, Vasodilatation, Anorexia, Flatulence, Rash, Visual disturbance, Urinary retention or frequency, Menopausal symptoms

• May cause dependence.

• Avoid alcohol and over-the-counter medications.

• May cause drowsiness, dizziness, and blurred vision.

• Avoid tasks requiring alertness and motor skills until response to drug is established.

• Inform physician if severe constipation, difficulty in breathing, excessive sedation, seizures, muscle weakness, tremors, chest pain, and palpitations occur.

Drug’s Name Classification Indication Action Contraindications/ Precautions

Adverse Reaction Patient/ Family Teaching

Cefuroxime cephalosporin For the treatment of many different types of bacterial infections such as bronchitis, sinusitis, tonsillitis, ear infections, skin infections, gonorrhea, and urinary tract infections.

Second-generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal.

* Contraindicated in patients hypersensitive to drug.* Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other beta-lactam antibiotics.* Use with caution in breast-feeding women and in patients with history of colitis or renal sufficiency.

CVphlebitis, thrombophlebitisGIpseudomembranous colitis, nausea, anorexia, vomiting, diarrheaHematologictransient neutropenia, eosinophilia, hemolytic anemia, thrombocytopeniaSkinmaculopapular and erythematous rashes, urticaria, pain, induration, sterile abscesses, temperature elevation, tissue sloughing at intramuscular injection siteOtherHypersensitivity reactions, serum sickness, anaphylaxis.

• Report loose stools or diarrhea promptly.

• Report any signs or symptoms of hypersensitivity

• Do not breast feed while taking this drug.

Drug’s Name Classification Indication Action Contraindications/ Precautions

Adverse Reaction Patient/ Family Teaching

Nalbuphine Narcotic agonist-antagonist analgesic

For the relief of moderate to severe pain.

Preoperative analgesia, as a supplement to surgical anesthesia, and for obstetric analgesia during labor and delivery

Nalbuphine acts as an agonist at specific opioid receptors in the CNS to produce analgesia, sedation but also acts to cause hallucinations and is an antagonist at µreceptors.

•Contraindications: hypersensitivity to nalbuphine, sulfites; lactation.•Use cautiously with emotionally unstable clients or those with a history of narcotic abuse; pregnancy prior to labor, labor or delivery, bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure, acute MI when nausea and vomiting are present, biliary tract surgery

CNS:Sedation. Clamminess, sweating headache, nervousness, restlessness, depression, crying, confusion, faintness, hostility, unusual dreams, hallucinations, euphoria, dysphoria, unreality, dizziness, vertigo, floating feeling, feeling of heaviness, numbness, tingling, flushing, warmth, blurred vision.CV:Hypotension, Hypertension, bradycardia, tachycardiaDERMATOLOGIC:Itching, burning, urticariaGI:Nausea, vomiting, cramps,

• Instruct patient on how and when to ask for pain medication.

• May cause drowsiness or dizziness. Advise patient to call for assistance when ambulating and to avoid driving or other activities requiring alertness until response to the medication is known.

• Caution patient to change positions slowly to minimize orthostatic hypotension.

• Advise patient that frequent mouth rinses, good oral

dyspepsia, bitter taste, dry mouthGU:Urinary urgencyRESPIRATORY:Respiratory depression, dyspnea, asthma

hygiene, and sugarless gum or candy may decrease dry mouth.

• Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis .

• Advise patient to avoid concurrent use of alcohol or other CNS depressants with this medication.