Care Conference

DRUG THERAPEUTIC RECORD Drug/Dose/ Frequency/Route 1. Forgram 1 gram IVTT every 12 hours

Classification/ Mechanism Cephalosporins Ceftriaxone Na The cephalosporins interfere with a final in the formation of the bacterial wall 9inhibition of mucopeptide biosynthesis), resulting in unstable cell membranes that undergo lysis (same mechanism of the action as penicillins). Also, cell division and growth are inhibited. The cephalosporins are most effective against young, rapidly dividing organisms and are considered bactericidal. Cephalosporins are widely disturbed to most tissues and fluids. First and second-generation drugs do not enter the CSF well but thirdgeneration drugs enter inflamed meninges readily. Rapidly excreted by the kidneys.

Indications/Contraindications/ Side Effects Indications: Treatment of infections of the lower resp tract, acute bacterial otitis media, skin & skin structure infection, UTI, uncomplicated gonorrhea, pelvic inflammatory disease, bacterial septicemia, bone & joint infections, intra-abdominal infections, meningitis. Contraindications: Hypersensitivity to cephalosporins. Hypersensitivity to lidocaine (IM inj). Side Effects: Increase serum creatinine, presence of casts in the urine, alteration of PTs (rare). Adverse Reactions: Local injection site & hypersensitivity reactions, GI disturbances, pseudomembranous colitis, eosinophilia, thrombocytopenia, leukopenia, elevations of AST, ALT & BUN, headache, dizziness, moniliasis or vaginitis, diaphoresis, flushing.

Principle of Care

Treatment

Safe use in pregnancy and lactation has not been established. Use with caution in the presence of impaired renal or hepatic function, together with other nephrotoxic drugs, and in clients over 50 years of age.

Parenteral solutions infused too rapidly may cause pain and irritation; dilute and infuse over 30 min unless otherwise indicated and assess site. Do not mix drugs with other antibiotics. Stability of solutions for IM or IV use varies depending on the diluent used; check package insert carefully. Asssess for any GI disease especially colitis’ use drug cautiously and report any bruising/bleeding or diarrhea. Store below 30°C.

Evaluation

DRUG THERAPEUTIC RECORD Drug/Dose/ Frequency/Route 2. Tramal 50 mg slow IVTT every 6 hours RTC for 24 hours

Classification/ Mechanism Analgesics (Opioid) / Supportive Care Therapy Tramadol HCl A centrally acting analgesics not related chemically to opiates. Precise mechanism is not known. Two complimentary mechanism may be applicable: It may bind to mu-opioid receptors and inhibit reuptake of nonepinephrine and serotonin. The analgesic effect is only partially antagonized by the antagonist naloxone. Causes significantly less respiratory depression than morphine. Produces dependence of the muopioid type; however, there is little abuse. Tolerance occurs but is relatively mild; the withdrawal syndrome is not as severe as with other opiates. Rapidly absorbed after PO administration. Food Does not affect the rate or extent of absorption.

Indications/Contraindications/ Side Effects Indications: Moderate to severe chronic & acute pain, diagnostic procedure & surgery. Contraindications: Known hypersensitivity towards Tramal or any of the excipients. Acute intoxication with alcohol, hypnotics, analgesics, opioids and psychotropics. Patients who are receiving MAOIs or who have taken them within the last 14 days. Children or adolescents <14 years. Narcotic withdrawal treatment. Side Effects: nausea and dizziness vomiting, constipation, sweating, dry mouth, headache and muziness, palpitation, tachycardia, postural hypotension or cardiovascular collapse Gastrointestinal irritation (a feeling of pressure in the stomach, bloating) and dermal reactions (eg, pruritus, rash, urticaria), motorial weakness, changes in appetite, blurred vision and micturition disorders (difficulty in passing urine and urinary retention) changes in mood (usually elation, occasionally dysphoria), changes in activity (usually suppression, occasionally increase) and changes in cognitive and sensorial capacity. Allergic reactions (eg, dyspnea, bronchospasm, wheezing, angioneurotic edema) and anaphylaxis. Respiratory depression, agitation, anxiety, nervousness, insomnia, hyperkinesias, tremor and GI symptoms. Adverse Reactions: Sweating, dizziness, muzziness, vomiting, dry mouth. In rare cases, influence on CVS regulation, esp after IV administration, headache, retching, vomiting, constipation, GI irritation, skin reactions. In very rare cases, motor weakness, blurred vision, appetite changes, micturition disorders, psychic side effects eg mood, perception & activity changes, allergic reactions & anaphylaxis. Cerebral convulsions esp on co-medication w/ neuroleptics, increase in BP, bradycardia. If recommended dosage is exceeded considerably, possibility of resp depression cannot be excluded.

Principle of Care Use with great caution in those taking MAO inhibitors, as tramadol inhibits noepinephrine and serotonin uptake. Dosage reduction is recommended with impaired hepatic or renal function and in clients over 75 years of age. Use with caution in increased intracranial pressure or head injury, in epilepsy or in clients with an increased risk for seizures including head trauma, metabolic disorders, alcohol or drug withdrawal, use of certain drugs and CNS infections. Seizures may occur in any client, especiallyif the dose is increased. Tramadol may complicate the assessment of acute abdominal conditions. Has abuse potential for clients.

Treatment Assess for history of drug addiction, allergy to opiates or codeine or seizures; drug may increase risk of convulsions. Take only as directed. May be taken without regard to meals. Do not exceed single or daily doses of tramadol; do not share meds, store safely out of reach of child. Do not perform activities that require mental alertness; drug may cause drowsiness and impair mental or physical performance. Alcohol may intensify drug effects. Report lack or response. Review list of side effects that one may experience and report if persistent or intolerable. Store at temperatures not exceeding 30°C.

Evaluation

DRUG THERAPEUTIC RECORD Drug/Dose/ Frequency/Route 3. Plasil 10mg IV one close in severe nausea and vomiting

Classification/ Mechanism Metoclopramide Pharmacology: Metoclopramide, a dopamine antagonist, stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary or pancreatic secretions. Its mode of action is unclear. It seems to sensitize tissues to the action of acetylcholine. The effect of metoclopramide on motility is not dependent on intact vagal innervation but it can be abolished by anticholinergic drugs. Metoclopramide increases the tone and amplitude of gastric (especially antral) contractions, relaxes the pyloric sphincter and the duodenum and jejunum, resulting in accelerated gastric emptying and intestinal transit. It increases the resting tone of the lower esophageal sphincter.

Indications/Contraindications/ Side Effects Indications: Disturbances of gastrointestinal motility, including gastroesophageal reflux and diabetic gastroparesis (diabetic gastric stasis). Nausea and vomiting of central and peripheral origin associated with surgery, metabolic diseases, infectious diseases, migraine headache, or drugs including cancer chemotherapy. To facilitate small bowel intubation and radiological procedures of gastrointestinal tract. Contraindications: gastrointestinal hemorrhage, obstruction or perforation; epilepsy; clients taking drugs like to cause extrapyramidal symptoms, such as phenothiazines. Pheochromocytoma. Side Effects: CNS; restlessness, drowsiness, fatigue, anxiety, insomnia, confusion, headache, dizziness, extrapyramidal symptoms GI: nausea, bowel disturbances CV: hypertension, hypotension bradycardia Endocrine: Galactorrhea, amenorrhea, impotence, fluid retention. Adverse Reactions:

Restlessness, drowsiness, fatigue & lassitude. Extrapyramidal symptoms, insomnia, headache, dizziness, nausea, galactorrhea, gynecomastia, rash including urticaria, bowel disturbances. Increased prolactin levels; gastroparesis.

Principle of Care

Treatment

Use with caution during lactation and in hypertension. Extrapyramidal effects are more likely to occur in children and geriatric clients.

Inject slowly IV over 12 min to prevent transient feelings of anxiety and restlessness. Metoclopramide is physically and/or chemically incompatible with a number of drugs; check package nsert if drug is to be mixed. Assess abdomen for bowel sounds and distention; note any nausea and vomiting. Report lack of response or any persistent side effects so they can be properly evaluated and counteracted. Avoid alcohol and any other CNS depressants. Extrapyramidal effect (trembling hands, facial grimacing) should be reported; may be treated with IM diphenhydramide.

Evaluation