Name of Patient: Marlin Ponce

Age: 19 years old

Chief Complaint: sustained a single stab wound to the left chest in the mid axillary line, just below the level of the nipple

Drug Name Classification Mechanism Dosage Indications Contraindications Adverse Nursing

of Reaction Responsibilities
Action

Generic Name: Therapeutic Binds with Injectio • Adjunct • Contraindicated in CNS: asthenia, Respiratory depression or death can occur even
fentaNYI citrate class: Opioid opioid n: 50 to general patients intolerant to drug. clouded sensorium, when transdermal drug has been used as
Brand Names: analgesics receptors in mcg/mL anesthetic Black Box Warning] Opioids con-fusion, recommended and has not been misused or
Abstral, Actiq, the CNS, should only be prescribed euphoria, sedation, abused. Drug should only be prescribed by health
Fentora Pharmacologic altering with benzodiazepines or somnolence, care providers knowledgeable in the use of potent
class: Opioid perception of other seizures, anxiety, opioids for management of long-term pain. Drug is
agonists and CNS depressants to depression, contraindicated for use in conditions in which the
emotional patients for whom alter. dizziness, hal- risk of life-threatening respiratory depression is
response to native treatment options lucinations, significantly increased. Transdermal patch is for
pain. are inadequate. I Black Box headache, hospital use only. a
Warning Transdermal form nervousness. CV; Black Box Warning Regularly monitor patients for
contraindicated in patients arrhythmias, chest development of opioid addiction, abuse, and
hypersensitive to ad- pain, HTN, hypoten- misuse. I Black Box Warning Serious, life-
hesives, those who are sion, DVT, PE. EENT: threatening or fatal respiratory depression can
opioid-naive, those who pharyngitis, dry occur. Monitor patient closely, especially within
need postoperative pain eyes, swelling, first 24 to 72 hours of drug initiation and after
management, and those strabismus, ptosis, dosage increase. O
with acute, mild, or epistaxis, nasal © Alert: If patient is taking opioids with sero-
intermittent pain that can discomfort, tonergic drugs, monitor for signs and symptoms of
be managed with rhinorrhea, nasal serotonin syndrome (agitation, hallu-cinations,
nonopioids. congestion, rapid HR, fever, excessive sweat-ing, shivering or
Don't use in patients with postnasal drip, shaking, muscle twitching or stiffness, trouble with
increased intracranial rhinitis (intranasal). coordination, nausea, vomiting, diarrhea),
pressure, head injury, Gl: con-stipation, especially when starting treatment or increasing
impaired con-sciousness, abdominal pain, dosage. Symptoms may occur within several hours
or coma. anorexia, diarrhea, of coadmin-istration but may also occur later,
Black Box Warning dyspepsia, dry especially after dosage increase. Discontinue the
Transmucosal forms mouth, ileus, opioid, serotonergic drug, or both if serotonin
contraindicated in those nausea, vomit-ing. syndrome is suspected.
who need acute or GU: urine retention. © Alert: Monitor patient for signs and symptoms
postoperative pain Musculoskeletal: of adrenal insufficiency (nausea, vomit-ing, loss of
management. I Black Box skeletal muscle appetite, fatigue, weakness, dizzi-ness, low BP).
Warning Nasal spray is rigidity (dose- Perform diagnostic testing if adrenal insufficiency
contraindicated in opioid- related). Res- is suspected. If adrenal insufficiency is confirmed,
nontolerant patients and in piratory: apnea, treat with corticosteroids and wean patient off
those who need acute or hypoventilation, opioids if ap-propriate. Discontinue corticosteroids
postoperative pain respiratory when clinically appropriate.
management. depression, © Alert: Don't stop drug abruptly; withdraw slowly
Black Box Warning] Drug dyspnea, cough, and individualize the gradual taper plan to prevent
may increase risks of opioid URI, brog-chitis. signs and symptoms of with-drawal, worsening
addiction, abuse, and Skin: diaphoresis, pain, and psychological distress in physically
misuse, which can lead to pruritus, erythema dependent patients. Refer to manufacturer's label
overdose and death. Risks at application site for specific tapering instructions.
increase in patients with a (transdermal). © Alert: When tapering opioids, monitor patient
personal or family history Ocher physical closely for signs and symptoms of opioid
of substance abuse or dependence. withdrawal (restlessness, lacrimation, rhin-orrhea,
mental illness. yawning, perspiration, chills, myal-gia, mydriasis,
Assess risks before drug is irritability, anxiety, insomnia, backache, joint pain,
prescribed. I weakness, abdominal cramps, anorexia, nausea,
• Transdermal form is vomiting, diarrhea, increased BP or HR, increased
contraindicated in patients respiratory rate). Such symptoms may indicate a
with acute or severe need to taper more slowly. Also watch for suicidal
bronchial asthma, known thoughts, use of other substances, and mood
or suspected paralytic changes.
ileus, and GI obstruction. O Alert: Monitor patient for signs and symptoms of
Black Box Warning Refer to decreased sex hormone levels (low libido, erectile
manufacturer's instructions dysfunction, amenorrhea, in-fertility). If signs and
for REMS requirements. I symptoms occur, evaluate patient and obtain
© Alert: Drug may lead to laboratory testing.
rare but serious decrease • For better analgesic effect, give drug before
in adrenal gland cortisol patient has intense pain.
production. • Alert: High doses can produce muscle rigidity,
Alert: Drug may cause which can be reversed with neuromuscular
decreased sex hormone blockers; however, patient must be artificially
levels with long-term use. ventilated.
• Fentora contraindicated © Alert: Avoid use in patients at risk for increased
in patients with mucositis ICP.
more severe than grade 1. • Monitor circulatory and respiratory status and
*• Use with caution in urinary function carefully. Drug may cause
patients with brain tu- respiratory depression, hypotension, urine
mors, COPD, decreased retention, nausea, vomiting, ileus, or altered level
respiratory reserve, of consciousness, no matter how it's given.
potentially compromised • Periodically monitor postoperative vital signs and
respirations, hepatic or bladder function. Because drug decreases both
renal disease, or cardiac rate and depth of respira-tions, monitoring of
bradyarrhythmias. arterial oxygen saturation (Saoz) may help assess
• Use with caution in respiratory de-pression. Immediately report
elderly or debilitated respiratory rate below 12 breaths/minute,
patients. decreased respiratory volume, or decreased Sao,.
• Opioids can cause sleep- • Drug may cause constipation. Assess bowel
related breathing function and need for stool softeners and
disorders, including central stimulant laxatives.
sleep apnea (CSA) and Black Box Warning Fentanyl is an opioid agonist
sleep-related hypoxemia. and schedule Il controlled substance with potential
Opioid use increases risk of for abuse. Be alert for signs of misuse, abuse, or
CSA in a dose-dependent diversion. O Transdermal form
fashion. In patients who Black Box Warning Transdermal drug levels peak
present with CSA, consider between 24 and 72 hours after initial application
decreasing opioid dosage and dose increases. Monitor patients for life-
using best practices for threatening hypoventilation, especially during
opioid taper. these times.
Dialyzable drug: Unknown. • Fentanyl patches should be used only in patients
A Overdose S&S: CNS age 2 or older who are opioid tolerant, who have
depression, respiratory chronic moderate to severe pain poorly controlled
depression, apnea, flaccid by other drugs, and who need a total daily opioid
skeletal mus-cos, dose at least equivalent to the 25-mcg/hour
bradycardia, hypotension, fentanyl patch.
circulatory • When converting patient from another opi-oid,
collapse. determine the initial fentanyl dosage with great
care; overestimating the dosage could be
PREGNANCY-LACTATION- dangerous or fatal.
REPRODUCTION • Identify all daily drugs, particularly
• There are no well- CYP3A4 inhibitors, which may increase fentanyl
controlled studies in levels.
pregnant women. Use • Monitor patients closely, and provide immediate
during pregnancy only if care for evidence of overdose, such as slow or
potential benefit justifies shallow breathing, a slow heart-beat, severe
potential risk to sleepiness, cold and clammy skin, trouble walking
the fetus. and talking, and feeling faint, dizzy, or confused.
Black Box Warning • Give patients detailed instructions for using
Prolonged maternal use of fentanyl patches correctly and safely.
opioids during pregnancy • Make dosage adjustments gradually in patient
can cause neonatal using the transdermal system. Reaching steady-
withdrawal syndrome, state level of a new dosage may take up to 6 days;
which may be life- delay dosage adjustment until after at least two
threatening and requires applications.
management by • Monitor patient who develops adverse reactions
neonatology experts. to the transdermal system for at least 12 hours
Advise patient of the risk of after removal. Drug level drops gradually; it may
neonatal withdrawal take as long as 17 hours to decline by 50%.
syndrome. O • Most patients experience good control of pain
• Drug appears in human for 3 days while wearing the transdermal system,
milk. Refer to individual but a few may need a new application after 48
manufacturer's instructions hours.
for use in breastfeeding • Because the drug level rises for the first
women. • 24 hours after application, analgesic effect can't
be evaluated on the first day. Make sure patient
has adequate supplemental analgesic to prevent
breakthrough pain. • When reducing opioid
therapy or switching to a different analgesic,
withdraw the transdermal system gradually.
Because the drug level drops gradually after
removal, give half the equianalgesic dose of the
new analgesic 12 to 18 hours after removal.
4 Alert: Transdermal patches must be stored, used,
and disposed of properly to prevent poisonings or
other harm, especially to children and pets. A
patch that has been worn for 3 days may still
contain enough fentanyl to cause harm, or even kill
a child or pet.
Patches should only be handled by patient or
patient's caregivers.
Intranasal and transmucosal forms
Black Box Warning Intranasal and transmu-cosal
forms are used only to manage breakthrough
cancer pain in patients who are already receiving
and tolerating opioids. I Black Box Warning
Intranasal and transmu-cosal forms aren't
bioequivalent and can't be substituted on a
microgram-per-microgram basis. I
• Look alike- sound alike: Don't confuse fentanyl
with alfentanil.
PATIENT TEACHING
Black Box Warning Caution patient or caregiver of
patient taking an opioid with a benzo-diazepine,
CNS depressant, or alcohol to seek immediate
medical attention for dizziness, light-headedness,
extreme sleepiness, slowed or difficult breathing,
or unresponsiveness.
Black Box Warning Advise patient that drug
increases risk of opioid addiction, abuse, and
misuse, which can lead to overdose and death.
Teach patient proper use of drug. I
• When drug is used for pain control, instruct
patient to request drug before pain becomes
intense.
© Alert: Encourage patient to report all
medications being taken, including prescription
and OTC medications and supplements.
© Alert: Caution patient to immediately re port
signs and symptoms of serotonin sym drome,
adrenal insufficiency, and decreased sex hormone
levels to health care provider.
© Alert: Counsel patient not to discontinue opioids
without first discussing need for a gradual tapering
regimen with prescriber.
• Teach patients that naloxone is prescribed in
conjunction with the opioid when begin ning and
renewing treatment as a preventive measure to
reduce opioid overdose and death.
. Tell home care patient to avoid drinking alcohol
or taking other CNS-type drugs, unless specifically
prescribed by practitioner, because additive effects
can occur.
• Teach patient about proper application of
transdermal patch. Tell patient to clip hair at
application site but not to use a razor, which nay
irritate skin. Wash area with clear wa-her, if
needed, but not with soaps, oils, lotions, alcohol,
or other substances that may irritate skin or
prevent adhesion. Dry area completely before
application.
• Tell patient to remove transdermal system from
package just before applying, hold in place for 30
seconds, and be sure the edges of patch stick to
skin.
© Alert: Teach patient not to alter the transdermal
patch (such as by cutting it) before applying.
• Advise parent or caregiver to place transdermal
patch on the upper back for child or patient who's
cognitively impaired, to reduce chance the patch
will be removed and placed in the mouth.
• Teach patient to dispose of the transdermal
patch by folding it so the adhesive side adheres to
itself and then flushing it down the toilet.
• Tell patient that, if another patch is needed after
48 to 72 hours, to apply it to a different skin site.
• Tell patient that pain relief with the patch may
not occur for several hours after the patch is
applied. Oral, immediate-release opioids may be
needed for initial pain relief.
Black Box Warning Inform patient that heat from
fever or environment, such as from heating pads,
electric blankets, heat lamps, hot tubs, or water
beds, may increase transdermal delivery and cause
toxicity requiring dosage adjustment. Instruct
patient to notify prescriber if fever occurs or if
patient will be spending time in a hot climate: I
© Alert: Instruct patient that if an MRI is re-quired,
to inform the facility that patient is wearing a
transdermal patch.
• Teach patient proper administration of
transmucosal forms.
° Advise patient that transmucosal lozenge
contains 2 g sugar per unit.
• Teach patient proper administration of the nasal
spray, and explain that a fine mist isn't always felt
and to rely on the audible click and advancement
of the dose counter.

Black Box Waning Warn patient and patient's

family that the amount of drug in trans-mucosal
and intranasal forms can be fatal to a child. Advise
patient to keep medicine well secured and out of
children's reach.|
Name of Patient: Marlin Ponce
Age: 19 years old
Chief Complaint: sustained a single stab wound to the left chest in the mid axillary line, just below the level of the nipple

Drug Name Classification Mechanism Dosage Indications Contraindications Adverse Nursing

of Reaction Responsibilities
Action

Generic Therapeutic class: Binds with Adules: 5 to 15 Moderate • Drug should be CNS: clouded Use care when prescribing and
Name: Opioid analgesics opioid mg immediate- to severe prescribed only by health sensorium, dizziness, administering oxycodone
oxyCODONE receptors in release form" or pain care professionals euphoria, light- concentrated oral solution, to avoid
Pharmacologic the ONS, oral solution PO knowledgeable in the use headedness, physical dosing er-tors due to confusion
class: Opioids altering every 4 to 6 of potent opioids for the dependence, seda-tion, between milligram and milliliter and
Brand perception of hours. Titrate management of chronic somnolence, headache, among other oxycodone solutions
Names: and dosage based on pain. asthenia, fever, with different concentrations, which
Xtampza ER emotional response. For Black Box Warning abnormal dreams, could result in accidental overdose
control of se- Opioids should only be confusion. CV: brady- and death.
vere, chronic prescribed with cardia, hypotension, Take care to ensure the proper dose is
pain, give on a benzodiazepines or other edema, flushing, HIN, communicated and dispensed. I Black
regularly CNS depressants to tachycardia. EENT: Box Warning Serious, life-threatening
scheduled basis patients for whom blurred vision, pharyn- or fatal respiratory depression can
every 4 to 6 alternative treatment gitis, rhinitis, sinusitis. occur. Monitor patient closely,
hours. options are inadequate. Gl constipation, nau- especially within first 24 to 72 hours of
Moderate to Alert: Patients are at sea, vomiting, ileus, starting drug and after a dosage
severe pain in increased risk for diarrhea, anorexia, gas- increase. I Black Box Warning
patients not oversedation and tritis. GU: urine Routinely monitor all patients on
currently respiratory depression if retention. Hematologic: opioids for signs and symptoms of
receiving opioids, they snore or have a anemia; decreased Hb misuse, abuse, and addiction. O Black
who need a history of slep apnea, level, platelet count, Box Warning Accidental ingestion of
continuous, haven't used opioids RBC count. Hepatic: even one dose of drug, especially by
around-the clock recently or are first time increased ALT level. children, can be fatal. "
analgesic for an opioid users, have Metabolic: © Alert: Carefully monitor vital signs,
extended period increased opioid dosage hypochloremia, pain level, respiratory status, and
of time requirements or opioid hyponatremia, sedation level in all patients receiving
habituation, have Te- hyperglycemia. opioids, especially those receiving IV
Adults: 10 mg ceived general anesthesia Musculoskeletal: weak- drugs, even when given
extended-release for longer lengths of time ness, arthralgia, back postoperatively.
tablets or 9 mg or received other pain, tremor. Respi- © Reassess patient's level of pain at
extended-release sedating drugs, have ratory: respiratory least 15 and 30 minutes after
capsules PO preexisting pulmonary or depression, cough, administration.
every cardiac disease, or have dysp-nea. Skin: ° For full analgesic effect, give drug
12 hours. May thoracic or other surgical diaphoresis, pruritus. before patient has intense pain.
increase dose incisions carefully. • Keep opioid antagonist (naloxone)
every 1 to that may impair and resuscitation equipment available.
2 days until breathing. Monitor © Alert: If patient is taking opioids
desired pain patients with sero-tomergic drugs, watch for
control is © Alert: Drug may lead to signs and symptoms of serotonin
achieved. rare but serious decrease syndrome (agitation, hal-lucinations,
For pediatric in adrenal gland cortisol rapid HR, fever, excessive sweat-ing,
dosing, refer to production. shivering or shaking, muscle twitching
manufacturer's © Alert: Drug may cause or stiffness, trouble with coordination,
recommendation decreased sex hormone nau-sea, vomiting, diarrhea),
s. levels with long-term use. especially at start of treatment or with
Adiust-a-dose: • Contraindicated in dosage increases. Signs and symptoms
For elderly or patients hypersensitive to may occur within several hours of
debilitated drufraindicated in known coadministration but may also occur
patients and or suspected par. alytic later, especially after dosage increase.
those with ileus, significant Discontinue opioid, serotonergic drug,
hepatic or renal respiratory depression, or both if serotonin syndrome is
impairment, or if and acute or severe suspected.
patient is bronchial asthma. © Alert: Monitor patient for signs and
receiving CNS • Use with caution in symptoms of adrenal insufficiency
depressants, elderly and debilitated (nausea, vomit-ing, loss of appetite,
decrease initial patients and in those fatigue, weakness, dizzi-ness, low BP).
starting dose by with head injury, Perform diagnostic testing if adrenal
one-third to one- increased ICP, seizures, insufficiency is suspected. If adrenal
half. asthma, COPD, prostatic insufficiency is confirmed, treat with
hyperplasia, severe corticosteroids and wean patient off
hepatic or renal dis-ease, opioids if ap-propriate. Discontinue
acute abdominal corticosteroids when clinically
conditions, urethral appropriate.
stricture, • Alert: Monitor patient for signs and
hypothyroidism, Addison symptoms of decreased sex hormone
disease, and arrhythmias. levels (low libido, erectile dysfunction,
Black Box Warning amenorrhea, in-fertility). If signs and
Serious, life-threatening, symptoms occur, evaluate patient and
or fatal respiratory obtain lab testing.
depression may occur • Patients taking extended-release
with use of extended- form around-the-clock may need to
release oxy. codone. take immediate-release form for
Monitor patient for worsening of pain or prevention of
respiratory de-pression, incident pain (e.g., breakthrough
especially during pain).
initiation of therapy and • Single-drug oxycodone solution or
after a dosage increase. tablets are especially useful for
Instruct patient to patients who shouldn't take aspirin or
swallow extended- acetaminophen.
release oxy. codone • Monitor circulatory and respiratory
tablets whole; crushing, status closely, especially within the
dissolving, or chewing the first 24 to 72 hours of initiation of
tablets can cause rapid therapy. Withhold dose and notify
release and absorption of prescriber if respirations are shallow
a potentially fatal dose of or if respiratory rate falls below 12
oxycodone. breaths/minute.
Black Box Warning] • Monitor patient's bladder and bowel
Accidental ingestion of pat-terns. Patient may need a
even one dose of drug, stimulant laxative because drug has a
especially by children, constipating effect.
can result in a fatal • Extended-release formula isn't
oxycodone overdose. I intended for as-needed use or for
Black Box Warning immediate postoperative pain. Drug is
Patients must be indicated only for postoperative use if
screened for increased patient was receiving it before surgery
risk of opioid abuse or if pain is expected to persist for an
(personal or family extended time.
history of substance © Alert: Drug is potentially addictive,
abuse or mental illness) even at recommended doses, and if
before being prescribed drug is misused.
opioids. Chewing, crushing, snorting, or
Black Box Warning injecting it can lead to overdose and
Oxycodone extended- death.
release tablets are • OxyContin has been formulated to
indicated for the manage prevent immediate access to full-dose
ment of moderate to oxycodone by cutting, chewing, or
severe pain, when a con- breaking the tablet.
tinuous, around-the-clock Attempts to dissolve tablets will result
opioid analgesic is in a gummy substance that can't be
needed for an extended drawn up into a syringe or injected.
period of time. © Alert: Don't stop drug abruptly;
They aren't intended for withdraw slowly and individualize
use as as-needed gradual taper plan to prevent signs
analgesics. a and symptoms of withdrawal,
Dialyzable drug: worsening of pain, and psychological
Unknown. distress in physically dependent
A Overdose S&S: CNS patients. Refer to manufacturer's label
depression, respiratory for specific tapering instructions.
depression, apnea, © Alert: When tapering opioids,
flaccid skeletal muscles, monitor patients closely for signs and
bradycardia, symptoms of opioid withdrawal
hypotension, circulatory (restlessness, lacrima-tion, rhinorrhea,
collapse, cardiac arrest, yawning, perspiration, chills, myalgia,
respiratory ar. mydriasis, irritability, anxiety, in-
rest, death, somnia, backache, joint pain,
weakness, abdominal cramps,
PREGNANCY-LACTATION- anorexia, nausea, vomiting, diarrhea;
REPRODUCTION increased BP or HR and increased
© Alert: Carefully weigh respiratory rate), which may indicate a
risks and benefts of using need to taper more slowly. Also
drug during pregnancy. monitor patients for suicidal thoughts,
Black Box Warning use of other substances, or changes in
Prolonged use of mood.
extended-release • Look alike-sound alike: Don't confuse
oxycodone during oxy-codone with hydrocodone,
pregnancy can result in Oxycontin, or oxymorphone. Don't
neonatal opioid confuse Oxycontin with MS Contin or
withdrawal syndrome, oxybutynin, or Roxicodone with
which may be life- Roxanol.
threatening if not
recognized and treated PATIENT TEACHING
and requires Black Box Warning Caution patient or
management according caregiver of patient taking an opioid
to protocols developed with a benzo-diazepine, CNS
By neonatology experts. depressant, or alcohol to seek
If prolonged use is immediate medical attention if patient
required, advise patient experiences dizziness, light-
of risks and ensure headedness, extreme sleepiness,
appropriate treatment is slowed or difficult breathing, or
available. unresponsiveness. I
• There are no adequate Black Box Warning Advise patient that
studies in pregnant drug increases risk of opioid addiction,
women. Use only if abuse, and misuse, which can lead to
potential benefit justifies overdose and death. Teach patient
potential risks to the proper use of drug. I
fetus. • Instruct patient to take drug before
• Drug isn't pain is intense.
recommended for use .• Explain assessment and monitoring
during or immediately process to patient and family. Instruct
before labor as uterine them to immediately report difficulty
contractions may be breathing or other signs or symptoms
adversely affected. of a potential ad. verse opioid-related
• Naloxone should be reaction.
available to reverse Tell patient to take drug with milk or
opioid-induced after
respiratory depression in eating.
the Black Box Warning Instruct patient or
neonate. care. giver to keep drug out of the
• Drug appears in human reach of chil dren because accidental
milk. Breastfeeding isn't ingestion can result in a fatal
recommended. oxycodone overdose. Advise patient or
• Long-term opioid use caregiver that if accidental inges. tion
may cause secondary occurs, to seek emergency medical
hypogonadism, which help immediately.|
may lead to sexual Black Box Warning Tell patient to
dysfunction or infertility. swallow extended-release tablets
whole. I © Alert: Encourage patient to
report all medications being taken,
including prescription and OTC
medications and supplements.
© Alert: Caution patient to
immediately report symptoms of
serotonin syndrome, adrenal
insufficiency, and decreased sex
hormone levels.
• Caution ambulatory patient about
getting out of bed or walking. Warn
outpatient to avoid driving and other
hazardous activities that require
mental alertness until drug's CNS
effects are known.
• Advise patient to avoid alcohol use
during
therapy.
• Tell patient not to stop drug
abruptly.
• Inform patient that urine drug
testing and review of state
prescription drug monitoring program
will be done periodically.
• Teach patient that naloxone is
prescribed in conjunction with the
opioid when treatment begins or is
renewed as a preventive measure to
reduce opioid overdose and death.
© Alert: Counsel patient not to
discontinue opioids without first
discussing with prescriber the need for
a gradual tapering regimen.
Name of Patient: Marlin Ponce
Age: 19 years old
Chief Complaint: sustained a single stab wound to the left chest in the mid axillary line, just below the level of the nipple

Drug Name Classification Mechanism Dosage Indications Contraindications Adverse Nursing

of Reaction Responsibilities
Action
Generic Therapeutic Binds with Adults: Moderate to • Contraindicated in patients CNS: dizziness, Black Box Warning Assess each patient's
Name: class: Opioid opioid Initially, 10 severe pain hypersensi five to drug and in drowsiness, risk of addiction, abuse, or misuse before
morphine analgesics receptors in mg (based those with conditions that headache, eu- prescribing extended-release or long-
the CNS, on 70 kg in- would prechnial a phoria, light- acting forms of morphine sulfate, and
Pharmacologic altering dividual) IM administration of opiod, (acute headedness, monitor all patients regularly for
class: Opioids perception of or 0.1 to 0.2 bronchial asthma or upper nightmares, seda- development of these behaviors. a
Brand and emotional mg/kg IV airway ob. struction). tion, somnolence, Black Box Warning Monitor patients for
Names: response to every 4 Black Box Warning Opioids seizures, respiratory depression, especially during
MS Contin, pain. hours p.r.n. should only be prescribed with depression, hallu- initiation of extended-release or long-
MS. IRS, Or, 15 to 30 benzodiazepines or other cinations, acting morphine sulfate or after a dosage
Statex mg CNS depressants to patients nervousness, increase. Seri-ous, life-threatening, or fatai
(immediate. for whom alter. native physical respiratory de-
release treatment options are dependence, pression may occur.
tablets) PO, inadequate. I Black Box syncope, anxiety. © Alert: If patient is taking opioids with
or 10 to 20 Warning Use of extended. CV: bradycardia, sero-tonergie drugs, watch for signs and
mg (oral so- release or long-acting cardiac arrest, symptoms of serotonin syndrome
lution) PO, morphine sulfate forms may shock, HTN, (agitation, hallucinations, rapid HR, fever,
or 10 to 20 increase the risk of addiction, hypotension, excessive sweating, shivering or shaking,
mg PR every abuse, and misuse, even at tachycar-dia, muscle twitching or stiffness, trouble with
4 hours recommended doses, and has palpitations, coordi-nation, nausea, vomiting, diarrhea),
a greater risk of overdose and peripheral especially at start of treatment and at
death. Reserve their use for circulatory col- dosage increases.
patients for whom alternative lapse, peripheral Signs and symptoms may occur within
treatment options are edema, chest pain, several hours of coadministration but may
ineffective, not toler-ated, or syncope. also occur later, especially after dosage
are otherwise insufficient to EENT: miosis, increase.
provide adequate pain blurred vision. Gli Discontinue the opioid, serotonergic drug,
management. I Black Box consti-pation, or both if serotonin syndrome is
Warning Accidental ingestion nausea, vomiting, suspected.
of even one dose of extended- anorexia, biliary © Alert: Monitor patient for signs and
release or long-acting forms of tract spasms, dry symptoms of adrenal insufficiency
morphine sulfate, especially by mouth, ileus, (nausea, vomit-ing, loss of appetite,
children, can result in a fatal flatulence, ab. fatigue, weakness, dizzi-ness, low BP).
overdose. dominal pain. GUt Perform diagnostic testing if adrenal
Keep out of reach of children. I urine retention. insufficiency is suspected. If adrenal
© Alert: Drug may lead to a Hemato-logics insufficiency is confirmed, treat with
rare but serious decrease in thrombocytopenia, corticosteroids and wean patient off
adrenal gland cortisol anemia, leukope. opioids if ap-propriate. Discontinue
production © Alert: Drug may nia. Respiratory: corticosteroids when clinically
cause decreased sex hormone apnea, respiratory appropriate.
levels with long-term use. arrest, respiratory © Alert: Monitor patient for signs and
© Alert: Patients are at depression. Skin symptoms of decreased sex hormone
increased risk for oversedation diaphoresis, levels (low libido, erectile dysfunction,
and respiratory depression if edema, pruritus, amenorrhea, in-fertility). If signs and
they snore or have a history of skin flushing, pain at symptoms occur, evaluate patient and
sleep apnea, haven't used injection site. obtain lab testing.
opioids recently or are first- Other: decreased © Alert: Carefully monitor vital signs, pain
time opioid users, have libido. level, respiratory status, and sedation level
increased opioid dosage in all patients receiving opioids, especially
requirements or opioid those receiving IV drugs, even those given
habituation, have received postoperatively.
general anesthesia for longer • Reassess patient's level of pain at least
lengths oftime or received 15 and 30 minutes after giving
other sedating drugs, have parenterally and 30 minutes after giving
preexisting pulmonary or orally.
cardiac disease, or have • Alert: Extended-release capsules aren't
thoracic or other surgical for use on an as-needed basis.
incisions that may impair Black Box Warning Keep opioid antagonist
breathing. Monitor patients (naloxone) and resuscitation equipment
care-fully. available.
• Contraindicated in patients • Monitor circulatory, respiratory, bladder,
with Glob-struction. and bowel functions carefully. Drug may
• Use with caution in elderly cause hypotension, urine retention,
or debilitated patients and in nausea, vomiting, ileus, or altered level of
those with head injury, consciousness regardless of the route.
increased ICP, seizures, © Alert: Intrathecal dosage is usually one-
chronic pulmonary dis-ease, tenth of epidural dosage.
prostatic hyperplasia, severe Black Box Warning] Life-threatening
hepatic or renal disease, acute respiratory depression may occur with
abdominal conditions, by- morphine use, even when drug has been
pothyroidism, Addison used as recommended and not misused or
disease, and urethral stricture. abused. Proper dosing and titration are
• Use with caution in patients essential, and morphine should only be
with circulatory shock, biliary prescribed by health care providers
tract disease, CNS depression, knowledgeable in the use of potent
toxic psychosis, acute opioids for management of long-term
alcoholism, delirium tremens, pain. Monitor patients for respiratory
and seizure disorders. depres-sion, especially during initiation of
Dialyzable drug: Yes. morphine or after a dosage increase.
A Overdose S&S: Miosis, CNS Instruct patients to swallow morphine
depression, respiratory capsule whole; Kadian capsule can be
depression, apnea, flaccid opened and contents sprinkled on
skeletal muscles, bradycardia, applesauce and swallowed without chew-
hypotension, circulatory ing. Crushing, dissolving, or chewing
collapse, cardiac arrest, pellets within the capsule can cause rapid
respiratory ar-rest, death. release and absorption of a potentially
PREGNANCY-LACTATION- fatal dose of morphine.
REPRODUCTION • If respirations drop below 12 breaths/
© Alert: Carefully weigh risks minute, withhold dose and notify
and benefits of using drug in prescriber.
pregnant women. Drug should Black Box Warning Morphine has an abuse
he used in pregnancy only if liability similar to other opioid analgesics
need for opioid analgesia and may be misused, abused, or diverted.
clearly outweighs potential I « Alert: Extended-release tablets and
risks to the fetus. capsules aren't for use on an as-needed
Black Box Warning Prolonged basis for mild or acute pain or for
use of opioids during postoperative pain, unless patient has
pregnancy can result in already been receiving long-term opioid
neonatal opioid withdrawal therapy before surgery or if postoperative
syndrome, which may be life- pain is expected to be moderate to severe
threatening if not recognized and persist for an extended period.
and treated. and requires • Preservative-free preparations are
management according to available for epidural and intrathecal use.
protocols developed by • Epidural administration has been
neonatology experts. associated with less potential for
If opioid use is required for a immediate or late adverse effects than
prolonged pe-riod, apprise intrathecal administration;
pregnant patient of risk to the use epidural route whenever possible.
neonate and ensure • A constant IV infusion of naloxone, 0.6
appropriate treatment will be mg/hour, for 24 hours after intrathecal
available. injection may be used to reduce potential
• Because of the potential for adverse effects.
serious adverse reactions in Black Box Warning When the epidural or
breastfeeding infants, intrathecal route is used, observe patients
including respiratory in a fully equipped and staffed
depression, sedation, and environment for at least 24 hours after
possibly withdrawal symptoms the initial dose. E
upon cessation of morphine to • Infumorph isn't recommended for
the mother, patient should single-dose IV, IM, or subcut
discontinue breastfeeding or administration.
discontinue drug, taking into • Improper or erroneous substitution of
account importance of drug to In-fumorph 200 or 500 (10 or 25 mg/mL,
the mother. re-spectively) for regular Duramorph (0.5
• If morphine use is necessary or 1 mg/mL) is likely to result in serious
in a breastfeeding patient, use over-dose, leading to seizures, respiratory
cautiously. Limit use and depres-sion, and possibly fatal outcome.
supplement with nonopioid • When drug is given epidurally, monitor
agents. Monitor infant for patient closely for respiratory depression
increased sleepiness, difficulty up to 24 hours after the injection. Check
feeding or breathing, and respiratory rate and depth every 30 to 60
limpiess. minutes for 24 hours. Watch for pruritus
and skin flush-
ing.
• Morphine is drug of choice in relieving
MI pain, may cause transient decrease in
BP.
• An around-the-clock regimen best
manages severe, chronic pain. Verify
patient has a breakthrough pain
medication prescribed in addition to the
around-the-clock medication.
• Morphine may worsen or mask
gallbladder pain.
. Constipation is commonly severe with
maintenance dose. Ensure (that stool
softener or stimulant laxative is ordered.
when stopping therapy.
Taper morphine sulfate therapy gradually
Black Box Warning Each ampule of In-
fumorph and Duramorph contains a large
amount of a potent opioid that has been
3g-sociated with abuse and dependence
arnong. health care providers, Due to the
limited ins dications for this product, risk
of overdone, and risk of its diversion and
abuse, special measures should be taken
to control this prod. uct within the
hospital or clinic, Infumorph and
Duramorph should be subject to rigid aer
counting, rigorous control of wastage, and
restricted access. I
Black Box Warting] Accidental consump-
ton of morphine, especially by children,
can result in a fatal overdose of morphine.
I
1 Alert: Don't stop drug abruptly;
withdraw slowly and individualize gradual
taper plan to prevent signs and symptoms
of withdrawal, worsening pain, and
psychological distress in physically
dependent patients. Refer to
manufacturer's label for specific tapering
instruc-
tions.
• Alert: When tapering opioids, monitor
patient closely for signs and symptoms of
opioid withdrawal (restlessness,
lacrimation, thin-orrhea, yawning,
perspiration, chills, myal-gia, mydriasis,
irritability, anxiety, insomnia, backache,
joint pain, weakness, abdominal cramps,
anorexia, nausea, vomiting, diar-thea,
increased BP or HR, increased respiratory
rate), which may indicate a need to taper
more slowly. Also monitor patient for
suicidal thoughts, use of other substances,
and mood changes.
• Look alike sound alike: Don't confuse
morphine with hydromorphone. Don't
confuse
MS Contin with Oxycontin.
PATIENT TEACHING
Black Box Warning Caution patient or care
giver of patient taking an opioid with a
benzo diazepine, CNS depressant, or
alcohol to seek immediate medical
attention for dizziness, light-headedness,
extreme sleepiness, slowed or difficult
breathing, or unresponsiveness: I © Alert:
Explain assessment and monitoring
process to patient and family. Instruct
them to immediately report difficulty
breathing or other signs or symptoms of a
potential adverse opioid-related reaction.
Alert: Encourage patient to report all med.
cations being taken, including prescription
and OTC medications and supplements.
• Warn patient that morphine can cause
con-stipation.
© Alert: Caution patient to immediately
report signs and symptoms of serotonin
syn-drome, adrenal insufficiency, and
decreased sex hormone levels.
When drug is used after surgery,
encourage patient to tum, coush, deep-
breathe, and ise incentive spirometer to
prevent lung problems.
• Caution ambulatory patient about
getting out of bed or walking. Warn
outpatient to avoid driving and other
potentially hazardous activities that
require mental alertness until drug's
adverse CNS effects are known.
Black Box Warning Drinking alcohol or
taking drugs containing alcohol while
taking extended-release capsules may
cause additive
CNS effects and potentially fatal overdose.
Warn patient to read labels on OTC drugs
carefully for alcohol content and not to
use alcohol in any form. B
• Tell patient to swallow morphine sulfate
whole or to open capsule and sprinkle
beads or pellets on a small amount of
applesauce immediately before taking.
Black Box Warning Tell patient to keep
morphine oral preparations out of the
reach of children. In case of accidental
ingestion, advise patient to seek
emergency medical help immediately. D
• Teach patient that naloxone is
prescribed in conjunction with the opioid
when treatment begins or is renewed as a
preventive measure to reduce opioid
overdose and death.
© Alert: Counsel patient not to
discontinue opioids without first
discussing with prescriber the need for a
gradual tapering regimen.
© Alert: Warn patient not to crush, break,
or chew extended-release forms
Name of Patient: Marlin Ponce
Age: 19 years old
Chief Complaint: sustained a single stab wound to the left chest in the mid axillary line, just below the level of the nipple

Drug Name Classification Mechanism of Dosage Indications Contraindications Adverse Nursing

Action Reaction Responsibilities
Generic Name: Therapeutic Thought to PO Mild pain or Drug can cause acute liver CNS: agitation (IV), anxiety, Black Box Warning
class: Analgesics produce Adults: 325 to fever failure, which may require à liver fatigue, headache, insomnia, Many OTC and
acetaminophen analgesia by 650 mg PO transplant or cause death. Most pyrexia. CV: HTN, hy- prescription
inhibiting every 4 to 6 cases of liver injury are potension, peripheral edema, products contain
Pharmacologic prostaglandin hours. associated with drug doses periorbital edema, acetaminophen; be
Brand Names: class: Para- and other Or, two exceeding 4,000 mg/day and tachycardia (IV). Gl: nausea, aware of this when
aminophenol substances that extended- often involve more than one vom-iting, abdominal pain, calculating total
Acephen, ACET derivatives sensitize pain release acetaminophen-containing diarrhea, constipation (IV). daily dose. N
0, Arthritis Pain receptors. Drug caplets PO product. I © Alert: May cause GU: oliguria (IV). Hematologic: Black Box Warning
Relief o, Atasol may relieve fever every 8 hours. serious, potentially fatal skin hemolytic anemia, Use caution when
Forte & 0, through central Maximum, reactions, ineluding SJS, toxic leukopenia, neutropenia, pre-seribing,
Fortolin: action in the 3,250 mg epidermal necrolysis, and acute pancytopenia, anemia. preparing, and
Ofirmev, hypothalamic daily unless generalized exanthe-matous Hepatics jaundice. administering IV
Pediatrix* 0, heat-regulating un der health pustulosis. Reaction may occur Metabolic: hypoalbuminemia acetaminophen to
Rapid Actions o, center. care provider with first or subsequent use (IV), hypo-glycemia, avoid dosing errors
Taminol *. supervision, when acetaminophen is used as hypokalemia, hypervolemia, leading to
Triaminic Fever when 4 g monotherapy or when it is one hypo-magnesemia, accidental overdose
Reducer 9, daily component of combination drug hypophosphatemia (IV). Mus- and death. Be
Tylenol o (immediate- therapy. Monitor for reddening culoskeletal: muscle spasms, careful not to
release) may of the skin, rash, blisters, and extremity pain (IV). confuse dose in
be used. detachment of the upper surface Respiratory: abnormal breath milliGRAMS and
of the skin. sounds, dyspnea, hypoxia, dose in milliLITERS.
Stop drug immediately if skin atelectasis, pleural effu-sion, Be sure to base
reaction is sus-pected. pulmonary edema, stridor, dose on weight for
• Contraindicated in patients wheezing. patients weighing
hypersensitive to drug. IV form is (IV). Skin: rash, urticaria, less than 50 kg, to
contraindicated in patients with infusion-site pain (IV), properly program
severe hepatic impairment or pruritus. infusion pump, and
severe active liver disease. INTERACTIONS to ensure that total
• Use cautiously in patients with Drug-drug. Barbiturates, daily dose of
any type of liver disease, G6PD carbamazepine, hydantoins, acetaminophen
deficiency, chronic mal-nutrition, rifampin: High doses or long- from all sources
severe hypovolemia term use of these drugs may doesn't exceed
(dehydration, blood loss), or reduce therapeutic effects maximum daily
severe renal impairment (CrCI of and enhance hepatotoxic limit. "
30 mL/minute or less). effects of acetaminophen. • Consider reducing
• Use cautiously in patients with Avoid using together. total daily dose and
long-term alcohol use because Busulfan: May increase increasing dosing
therapeutic doses cause busulfan level. Monitor intervals in patients
hepatotoxicity in these patients. patient closely. with hepatic or
Chronic alcoholics shouldn't take Cholestyramine resin: May renal impairment.
more than 2 g of acetaminophen decrease acetaminophen PATIENT TEACHING
every 24 hours. absorption. Give at least 1 • Tell parents to
Dialyzable drug: Unknown. A hour after acetaminophen or consult prescriber
Overdose 58S: Stage I (up to 24 consider therapy change. before giving drug
hours-abdominal pain, Dasatinib: May enhance to children younger
diaphoresis, nausea, vom. iting, hepatotoxic effects of than age 2.
malaise, pallor, stage 2 (24 to 36 dasatinib and increase • Advise parents
hours) right upper quadrant acetaminophen level. Avoid that drug is only for
pain, elevated LFT results, use together. matinib, short-term use;
prolonged PT; stage 3 (72 to mipomersen: May increase urge them to
"6 hours)- hepatic failure, hepatotoxic effects of these consult prescriber if
encephalopatty, drugs. Monitor patient giving to infants for
coma. closely. longer than 3 days,
PREGNANCY: A CT ATEON- Isoniazid: May increase risk of children for longer
REPRODUCTOR acetaminophen adverse than 5 days, or
• Use cautiously in pregnant and effects. Monitor patient adults for longer
breastied ing women. Embryo- closely. than 10 days.
fetal risk is very low. Lamotrigine: Prolonged Black Box Warning
. There are no studies of IV acetaminophen use may Advise patient or
acetaminophen use in pregnant decrease lamotrigine level, care giver that many
women. Use during preg. nancy Monitor patient for OTC products
only if clearly needed. therapeutic effects; adjust contain
NURSING CONSIDERATIONS lamotri-gine dosage as acetaminophen and
Black Box Warning Many OTC needed. should be counted
and prescription products Lomitapide: May increase when calculating
contain acetaminophen; be lomitapide level. total daily dose. I
aware of this when calculating Limit maximum adult dose of • Tell patient to
total daily dose. N acetaminophen to 4 g or less consult prescriber
Black Box Warning Use caution daily for 3 or fewer days per for fever lasting
when pre-seribing, preparing, week or consider therapy longer than 3 davs
and administering IV change. or recurrent fever.
acetaminophen to avoid dosing Metyrapone, probenecid: May © Alert: Warn
errors leading to accidental increase acetaminophen level patient that high
overdose and death. Be careful and risk of hepatotoxicity. doses or unsi
not to confuse dose in Avoid use together. pervised long-term
milliGRAMS and dose in Warfarin: May increase use can cause liver
milliLITERS. Be sure to base dose hypoprothrom-binemic dam-age. Excessive
on weight for patients weighing effects with long-term use alcohol use may
less than 50 kg, to properly with high doses of increase the risk of
program infusion pump, and to acetaminophen. Monitor INR liver damage.
ensure that total daily dose of closely. Caution long-term
acetaminophen from all sources Drug-lifestyle. Alcohol use: alcoholics to limit
doesn't exceed maximum daily May increase risk of hepatic drug to 2 g/day or
limit. " damage. Discourage use to- less.
• Consider reducing total daily gether.
dose and increasing dosing
intervals in patients with hepatic
or renal impairment.
Name of Patient: Marlin Ponce
Age: 19 years old
Chief Complaint: sustained a single stab wound to the left chest in the mid axillary line, just below the level of the nipple

Drug Name Classification Mechanism of Dosage Indications Contraindications Adverse Nursing

Action Reaction Responsibilities
Generic Name: Therapeutic Inhibits bacterial Capsules: 75 Infections caused • Contraindicated in patients CV: thrombophlebitis. Gl: • IM injection may
class: Antibiotics protein mg, 150 mg, by sensitive hypersensitive to drug or nausea, pseu-domembranous raise CK level in
clindamycin synthesis by 300 mg. staply-lococci, lincomycin. Severe colitis, abdominal pain, di- response to muscle
binding to the clindamyein streptococci, hypersensitivity reactions arrhea, vomiting. irritation.
Pharmacologic 50$ subunit of palmitate pneumococci, requiring emergency Hematologic: thrombocy- • Monitor renal,
Brand Names: class: the ribosome. hydrochloride Bac-teroides, treatment have been topenia, transient leukopenia, hepatic, and
Lincomycin Granules for Fusobacterium, reported. Severe skin eosinophilia. hematopoietic
Cleocin derivatives oral solution: Clostridium per- reactions and DRESS Hepatic: jaundice. Skin: functions during
Pediatric, 75 mg/5ml fringens, or other syndrome have been maculopapular rash, urticaria. prolonged therapy.
Dalacin C sensitive aerobic reported. Discontinue drug if Others anaphylaxis. • Observe patient
Flavored and anaerobic these occur. INTERACTIONS for signs and
Granules organisms • Clindamycin use may Drug-drug. Live-virus vaccines: symptoms of
result in overgrowth of May decrease vaccine superinfection.
nonsusceptible organisms, effectiveness. Don't give • Alert: Don't give
particularly yeasts. Monitor together. opioid antidiarrheals
patient for sign of superin- Neuromuscular blockers: May to treat drug-
fection. increase neuromuscular induced diarrhea;
• Use cautiously in neonates blockade. Monitor patient they may prolong
and patients with renal or closely. and worsen this
hepatic disease, asthma, condition.
history of GI disease, or Black Box Warning
significant allergies. Diarrhea, colitis, and
• Severe or fatal reactions pseudomembranous
such as toxic epidermal colitis have
necrolysis have been developed up to 2
reported. Discontinue drug if months after
severe skin reaction occurs. cessation of drug
therapy. I
Black Box Warning • Drug doesn't
Clindamycin has been penetrate blood-
associated with brain barrier.
development of DAD, which PATIENT TEACHING
may evolve into severe, • Advise patient to
possibly fa-tal, colitis; its use take capsule form
should be reserved for with a full glass of
serious infections. If CDAD is water to prevent
suspected or con-firmed, esophageal irri-
drug may need to be tation.
discontinued and • Warn patient that
appropriate treatment IM injection may be
initiated. painful.
Dialyzable drug: No. • Tell patient to
report discomfort at
IV insertion site.
• Instruct patient to
report all adverse
reactions (especially
diarrhea and
hypersensitivity
reactions). Warn
patient not to self-
treat diarrhea
because drug may
cause life-
threatening colitis.
Name of Patient: Marlin Ponce
Age: 19 years old
Chief Complaint: sustained a single stab wound to the left chest in the mid axillary line, just below the level of the nipple

Drug Name Classification Mechanism of Dosage Indications Contraindications Adverse Nursing

Action Reaction Responsibilities
Generic Name: Therapeutic Exerts Capsules: 40 Infections • Contraindicated in CNS: intracranial HTN, NURSING CONSIDERATIONS
class: bacteriostatic mg, 50 mg, caused by patients headache. CV: peri-carditis, • If patient receives large doses of
Antibiotics effect by 75 mg, 100 susceptible hypersensitive to drug thrombophlebitis. Gl: prolonged therapy or if patient is at
doxycycline binding to the mg, gram-positive or other tetracyclines. diarthea, epi-gastric high risk, watch for signs and
30S and 150 mg and gram- • Use cautiously in distress, nausea, anorexia, symptoms of superinfection. If
Pharmacologi possibly 50S Injection: negative patients with impaired glossitis, dysphagia, superinfection occurs, drug should
Brand Names: c class: ribosomal 100-mg vial organisms renal or hepatic vomiting, oral candidiasis, be discontinued and appropriate
Tetracyclines subunits of Oral (including function. entero-colitis, anogenital therapy instituted.
Acticlate, microorganisms suspension: Haemophilus • CDAD has been inflammation. GUi vagini- • Cutaneous anthrax with signs of
Acticlate Cap, and inhibiting 25 mg/5 ml ducreyi, reported and may tis. Hematologic: systemic involvement, extensive
Atridox, Doryx, protein Tablets: 50 Versinia pestis, range in severity from neutropenia, thrombo- edema, or lesions on the head or
Doryx MPC, synthesis mg, 75 mg, Francisella mild diarrhea to fatal cytopenia, eosinophilia, neck requires IV therapy and a
Doxy 100, 100 mg, 150 tularensis, and colitis. hemolytic anemia. multidrug approach.
Morgidox, mg Campylobacter If CDAD is suspected Musculoskeletal: bone • Ciprofioxacin and doxycycline are
Vibramycin doxycycline fetus), or confirmed, ongoing growth retardation in first-line therapies for anthrax. If
doxycycline calcium Rickettsiae antibiotic use not children younger than age anthrax patient also has meningitis,
monohydrate Syrup: 50 species, directed against 8. Skin: mac-ulopapular ciprofioxacin is prefered because of
Apprion «, mg/5 ml Mycoplasma Clostridium difficile and erythematous rashes, better distribution to the CNS.
Vibramycin doxycycline pneumonia, may need to be photosensitivity reactions, • Drug may increase risk of
hyclate Chlamydia tra- discontinued. Institute increased pigmentation, intracranial HIN (IH) and
Capsules: 50 chomatis, or appropriate urticaria. Other: pseudotumor cerebri, especially in
mg, 100 mg Borrelia treatment. anaphylaxis, women who are overweight or
Injection: burgdorferi • In a fetus in the last hypersensitivity reactions, have a history of IH. Monitor
100 mg, 200 (Lyme disease); half of gestation or in superinfection, permanent patient for headache, blurred
mg Chlamydophila a child younger than discoloration of teeth, vision, diplopia, and vision loss. If
Periodontal psittacosis; age 8, drug may cause enamel defects. visual changes occur, prompt
system: 50 granu-loma permanently ophthalmic evaluation is needed.
mg inguinale discolored teeth, • Check patient's tongue for signs
Tablets: 20 enamel defects, and of fungal infection. Emphasize good
mg, 75 mg, bone growth oral hygiene.
100 mg, 150 retardation. Drug • Photosensitivity reactions may
mg shouldn't be used in occur within a few minutes to
Tablets this age-group unless several hours after exposure and
(delayed- other drugs aren't may last after therapy ends.
release) D: likely to be effective Discontinue drug at first evidence
50 mg, 75 or are contraindi- of skin erythema.
mg, 100 mg, cated, • Look alike-sound alike: Don't
120 mg, 150 • Use in patients age 8 confuse doxycycline with
mg, 200 mg and younger only doxylamine or dicyclomine.
when potential Don't confuse Oracea with Orencia.
benefits are expected PATIENT TEACHING
to outweigh risks in • Tell patient to take entire amount
severe or life- of drug exactly as prescribed, even
threatening con- if feeling better.
ditions, such as • Instruct patient to report adverse
anthrax or Rocky reactions promptly, especially signs
Mountain or symptoms
Name of Patient: Marlin Ponce
Age: 19 years old
Chief Complaint: sustained a single stab wound to the left chest in the mid axillary line, just below the level of the nipple

Drug Name Classification Mechanism of Dosage Indications Contraindications Adverse Nursing

Action Reaction Responsibilities
Generic Name: Therapeutic class: Inhibits cell-wall Capsules: 250 mg, Respiratory tract • Contraindicated in CNS: dizziness, • If large doses are
Antibiotics synthesis, promoting 500 mg, 750 mg infections caused by patients headache, fatigue, given or if therapy is
cephalexin osmotic instability; Oral suspension: 125 susceptible isolates hypersensitive to agitation, confusion, pro-
usually bactericidal. mg/S mL, 250 mg/5 of Streptococcus cephalosporins. hallucinations. Gl *longed, monitor
mL preu-moniae and • Use cautiously in anorexia, di-arrhea, patient for
Brand Names: Pharmacologic class: Tablets: 250 mg, 500 Streptococcus patients pseudomembranous superinfection and
First-generation mg progenes; GU tract hypersensitive to colitis, gastri-tis, diarrhea, especially
Apo-Cephalex I , cephalosporins infections caused by penicillin because of glossitis, dyspepsia, if patient is high risk.
Keflex® suscentible isolates possibility of cross- abdominal pain, anal . Treat group A beta-
of Escherichia coli, sensitivity with other pruritus, tenesmus, hemolytic
Proteus mirabilis, beta-lactam oral candidiasis. GUt streptococai
and Klebsiella antibiotics. genital pruritus, infections for a
pneumoniae; skin ° Severe candidiasis, vaginitis, minimum of 10 days.
and skin-structure hypersensitivity interstitial nephritis. • If anemia develops
Infections caused try reactions can oc-cur. Hematologies during or after
susceptible isolates If an allergic reaction neutropenia, cephalexin therapy,
of Staphylococcus occurs, discontinue thrombocytopenia, obtain a diagnostic
aureus or S. pyo- drug immediately eosinophilia, work-up for drug-
genes; bone and treat anemia. induced hemolytic
Infections caused try appropriately. Musculoskeletal: anemia, discontinue
suscep-fible isolates • Drug may increase arthritis, arthralgia, drug, and institute
of S. aureus and P risk of seizures. joint pain. Slain: appropriate therapy.
mirabills; and otitis Use cautiously in maculopapular and • Look alike sound
media caused by patients with history erythematous alike: Don't confuse
susceptible Isolates of seizures. rashes, urticaria. Keflex with Keppra.
of S. pneumoniae, • Use cautiously in Other: anaphylaxis, Don't confuse drug
Haemophilus patients with history hypersensitivity with other
influenzae, S. of colitis and in reactions, serum cephalosporins that
aureus, S. pyogenes, those with renal sickness. sound alike.
and Moraxella insufficiency. PATIENT TEACHING
catarrhalis • Tell patient to take
© Alert: Drug can drug exactly as pre-
cause superinfection scribed, even if
and feeling better.
DAD and • Instruct patient to
pseudomembranous take drug with food
colitisrag. ing from or milk to lessen GI
mild to life- discomfort.
threatening, which a ° Tell patient taking
occur even 2 months suspension form to
after therapy. shake container well
Dialyzable drug: before measuring
Unknown. dose and to store in
A Overdose S&.S: refrigerator.
Nausea, vomiting • Tell patient to
epig. tric distress, report all adverse
diarrhea, hematoria. reactions and to
PREGNANCY- immediately report
LACTATION- rash and signs and
REPRODUCTION symptoms of
• There are no superinfection or
adequate studies in diarrhea.
pregnam women.
Use during
pregnancy only if
leafy needed and
potential beneft
justifes potemia
risk to the fetus.
• Drug appears in
human milk. Use
cautiously in
breastfeeding
women.