Republic of the Philippines

UNIVERSITY OF EASTERN PHILIPPINES

COLLEGE of NURSING and ALLIED HEALTH SCIENCES

DRUG ANALYSIS
Name of the Patient: Adlawan, Jhian Kyle
Age: 7 yrs old
Chief Complaint: Fever/Rashes

Drug Name Dosage/ Mechanism of action Indication Contraindication Side /Adverse Effect Nursing Responsibility
Frequency/ Route

Generic Name: Oral or suppository: The analgesic and Analgesic- antipyretic in Hypersensitivity to SIDE EFFECTS BASELINE ASSESSMENT
Paracetamol 10-15 mg/kg/per antipyretic effects of patients with aspirin acetaminophen, severe
(acetaminophen dose orally/rectally. paracetamol are allergy, hemostatic hepatic impairment or Rare: Hypersensitivity If given for analgesia, assess
) believed to be related disturbances, bleeding severe active liver reaction. onset, type, location, duration
Brand Name: Neonates: to the inhibition of diatheses, upper Gl disease. of pain. Effect of medication is
For babies born at ADVERSE reduced if full pain response
Suppositories: prostaglandin disease, gouty arthriti
28-31 weeks of Cautions: EFFECTS/TOXIC recurs prior to next dose.
Abenol (CAN), synthetase (a
gestation: Arthritis and rheumatic REACTIONS Assess for fever. Assess LFT in
Acephen mechanism shared by
Every 12 hours; disorders involving Sensitivity to pts with chronic usage or
ASA and related drugs). Early Signs of
Oral: Aceta, dose to not exceed musculoskeletal pain acetaminophen; severe history of hepatic impairment,
It is postulated that the Acetaminophen
Apacet, Atasol 40 mg/kg/day. (but lacks clinically renal impairment; alcohol abuse.
analgesic effect is Toxicity: Anorexia,
(CAN), significant alcohol dependency,
produced by elevation nausea, diaphoresis,
Genapap, For babies born at antirheumatic and anti- hepatic impairment, or INTERVENTION/EVALUATION
of the pain threshold fatigue within first 12–
Genebs, 32-37 weeks of inflammatory effects) active hepatic disease;
and the antipyretic 24 hrs. Assess for clinical
Liquiprin, gestation: chronic malnutrition
effect Is produced Later Signs of Toxicity: improvement and relief of
Mapap, Panadol, Every 8 hours; dose Common cold, flu, other and hypovolemia
through action on the Vomiting, right upper pain, fever. Therapeutic serum
Tapanol, to not exceed 60 viral and bacterial (Ofirmev); G6PD
hypothalamic heat- quadrant tenderness, level: 10-30 mcg/mL; toxic
Tempra, mg/kg/day. infections with pain and deficiency (hemolysis
regulating centre. elevated LFTs within serum level: greater than 200
Tylenol fever may occur). Limit dose
For term babies, 0-9 to less than 4 g/day 48–72 hrs after mcg/mL. Do not exceed
days of life: Every 6- Unlabeled use: ingestion. maximum daily recommended
Classification:
 8 hours; dose to not Hematologic: dose: 4 g/day.
Pharmacothera exceed 60 Prophylactic for
peutic: mg/kg/day. children receiving DPT Methemoglobinemia PATIENT/FAMILY TEACHING
Central vaccination to reduce -cyanosis; hemolytic
analgesic. For term babies, 10- incidence of fever and anemia-hematuria,  Consult physician for
29 days of life: pain. anuria; neutropenia, use in children
Clinical: Every 4-8 hours; leukopenia, younger than 2 yrs,
Nonnarcotic dose to not exceed pancytopenia, oral use longer than 5
analgesic, 90 mg/kg/day. thrombocytopenia, days (children) or
antipyretic. hypoglycemia. longer than 10 days
Infants: (adults), or fever
Every 4-6 hours; lasting longer than 3
dose to not exceed days.
75 mg/kg/day.  Severe/recurrent pain
or high/continuous
Children and
fever may indicate
adolescents (<60
serious illness.
kg):
 Do not take more than
Every 4-6 hours;
4 g/day (3 g/day if
dose to not exceed 1
using OTC [over-the-
g/dose or 75
counter]). Actual OTC
mg/kg/day.
dosing
>12 years: 325-650 recommendations
mg every 4-6 hours; may vary by product
dose to not exceed and/or manufacturer.
3.25-4 g/day. Many nonprescription
combination products
contain
acetaminophen. Avoid
alcohol.

Drug Name Dosage/ Mechanism of action Indication Contraindication Side /Adverse Effect Nursing Responsibility
Frequency/ Route
Generic Name: IV, IM:  Cefuroxime Respiratory Tract Hypersensitivity to SIDE EFFECTS: BASELINE ASSESSMENT:
Cefuroxime binds to one or Infections: Cefuroxime is Cephalosporins:
ADULTS, ELDERLY: more of the commonly used to treat Frequent: Discomfort Obtain CBC, renal function test.
penicillin- respiratory Cefuroxime is with IM administration, Question for history of
750 mg–1.5 g q8h contraindicated in allergies, particularly
Brand Name: binding tractinfections, oral candidiasis
individuals with a
Ceftin, Cefuroxi up to 1.5 g q6h for proteins including: (thrush), mild diarrhea, cephalosporin’s, penicillin’s.
known hypersensitivity
me, Zinacef severe infections. (PBPs) which or allergy to mild abdominal
inhibits the  Community- cephalosporin cramping, vaginal
INFANTS, final acquired antibiotics. candidiasis.
CHILDREN, INTERVENTION/EVALUATION
Classification: transpeptidati pneumonia
Pharmacothera ADOLESCENTS:  Acute Cross-reactivity with Occasional: Nausea,
on step of Assess oral cavity for white
peutic: Second- penicillins may also serum sickness–like
peptidoglycan bronchitis patches on mucous
Mild to moderate occur in some cases.
generation synthesis in  Acute reaction (fever, joint membranes, tongue (thrush).
cephalosporin. infection: 75–100 exacerbations pain; usually occurs
bacterial cell History of Severe Monitor daily pattern of bowel
mg/kg/day divided of chronic after second course of
wall, thus Allergic Reactions: activity, stool consistency. Mild
Clinical: q8h. bronchitis therapy and resolves
inhibiting GI effects may be tolerable
Antibiotic. biosynthesis  Pharyngitis and Individuals with a after drug is (increasing severity may
Maximum: 1,500 history of severe allergic discontinued).
and arresting tonsillitis indicate onset of antibiotic-
mg/dose. reactions, including
cell wall anaphylaxis, to any associated colitis). Monitor
assembly Urinary Tract Infections: Rare: Allergic reaction
Severe infection: cephalosporin or I&O, renal function tests for
resulting in Cefuroxime is effective (rash, pruritus,
100–200mg/kg/day penicillin should not use nephrotoxicity. Be alert for
bacterial cell against urinary tract cefuroxime. urticaria),
divided into 3–4 superinfection: fever,
death. infections caused by thrombophlebitis (pain,
doses. vomiting, diarrhea
susceptible bacteria. It is Clostridium difficile- redness,swelling at
aanal/genital pruritus, oral
Absorption: commonly used or Associated Disease: injection site).
Mximum: 1,500 mucosal changes (ulceration,
uncomplicated urinary pain, erythema).
mg/dose. Cefuroxime, like other
Absorbed from the GI tract infections.
antibiotics, may
NEONATES: 50 tract with peak plasma
Skin and Soft Tissue contribute to the ADVERSE
mg/kg/dose q8– concentrations after 2-
Infections: Cefuroxime is overgrowth of EFFECTS/TOXIC PATIENT/FAMILY TEACHING
12h. 3 hr (oral); may be
used to treat skin and Clostridium difficile, REACTIONS:
enhanced by the
soft tissue infections, leading to  Discomfort may occur
PO: ADULTS, presence of food.
such as cellulitis and pseudomembranous Antibiotic-associated with IM injection.
ELDERLY: 250–500 colitis. It is generally colitis, other  Doses should be
mg twice daily Distribution: Pleural impetigo.
 evenly spaced.
INFANTS, and synovial fluid, Bone and Joint contraindicated in superinfections  Continue antibiotic
sputum, bone and Infections: Cefuroxime patients with a history (abdominal cramps, therapy for full length
CHILDREN, aqueous fluids; CSF may be prescribed for of this condition. severe watery diarrhea, of treatment. May
ADOLESCENTS: 20– (therapeutic the treatment of bone fever) may result from cause GI upset (may
30 mg/kg/day in 2 concentrations). and joint infections, Renal Impairment (In altered bacterial balance take with food, milk).
divided doses. Crosses the placenta including osteomyelitis Some Cases): in GI tract.
and enters breast milk. and septic arthritis. Nephrotoxicity may
Maximum: 1 g/day Protein- binding: Up to Cefuroxime is excreted occur, esp. in pts with
(500 mg/dose). 50%. Gynecologic Infections: primarily through the preexisting renal
Cefuroxime can be used kidneys. In patients with disease. Pts with history
Metabolism: Rapidly to treat certain severe renal of penicillin allergy are
hydrolysed (intestinal gynecologic infections, impairment, dosage at increased risk for
mucosa and blood). such as pelvic adjustments may be developing a severe
inflammatory disease. necessary, and its use hypersensitivity
Excretion: Via the may be contraindicated reaction (severe
urine by glomerular in certain situations. pruritus, angioedema,
filtration and renal bronchospasm
tubular secretion (as Precaution in Neonates anaphylaxis).
unchanged); via bile with
(small amounts); 70 Hyperbilirubinemia:
min (elimination half-
life); prolonged in Although cefuroxime is
neonates and renal generally considered
safe for use in neonates,
impairment.
caution is advised in
those with
hyperbilirubinemia
(elevated bilirubin
levels).

Drug Name Dosage/ Mechanism of action Indication Contraindication Side /Adverse Effect Nursing Responsibility
Frequency/ Route

Generic Name: PO: Cetirizine, a human Used to relieve Hypersensitivity SIDE EFFECTS:
Citirizine metabolite of allergy-related
 FOR ADULTS AND hydroxyzine, is a symptoms. Its (Allergic Reaction): Frequent: Drowsiness BASELINE ASSESSMENT:
CHILDREN (6 second-generation primary or Sedation, headache,
Brand Name: YEARS AND antihistamine that indications Cetirizine should not be dry mouth, dizziness, Obtain CBC, renal function test.
Aller-tec, Aller- OLDER): works by selectively include: used by individuals who fatigue. Liver function test history of
tec D, Quzyttir, blocking H1 histamine are allergic to it or any allergies, particularly
Reactine, Standard Dose: receptors in the body.  Seasonal of its components. An Occasional: Nausea, sore antihistamines or any
Wal Zyr 24 10 mg once daily. Histamine, a chemical Allergic allergic reaction may throat, stomach pain or ingredients in cetirizine. .
Hour Allergy, released during allergic Rhinitis cause symptoms such as indigestion, increased
Wal Zyr D, Wal- Maximum Dose: rash, swelling, or appetite, back pain
reactions, binds to H1
zyr, Zerviate, 10 mg once daily  Perennial difficulty breathing.
receptors on various INTERVENTION/EVALUATION
Zyrtec, Zyrtec-D (do not exceed this allergic Rare: Severe allergic
cells, leading to
dose). rhinitis Severe Renal reaction, liver issues,
common allergy Assess for common side effects
Impairment: severe drowsiness or
FOR CHILDREN (2 symptoms such as  Chronic like headaches, drowsiness, or
sedation, tachycardia,
Classification: TO 5 YEARS OLD): itching, swelling, urticaria Cetirizine is primarily gastrointestinal discomfort.
urinary retention,
Selective redness, and increased (Hives) excreted through the Patients should also be
fainting or severe
Histamine-1 Recommended mucus production. By kidneys, so individuals informed that cetirizine can
dizziness, severe skin
Antagonist Dose: 2.5 mg once inhibiting these  Itching and with severe renal sometimes cause mild
reaction
daily. receptors, cetirizine Skin Rashes impairment (e.g., end- sedation, though less than
Clinical: effectively reduces stage renal disease) older antihistamines.
Antihistamine Maximum Dose: 5 these allergic Respiratory System: Encourage patients to follow
should avoid cetirizine
mg daily (if needed, responses. Specifically, Cetirizine is commonly ADVERSE up with their healthcare
or use it under strict
2.5 mg twice a day). it prevents histamine- used to treat symptoms EFFECTS/TOXIC provider if they experience any
medical supervision
induced vasodilation of allergic rhinitis, such REACTIONS: allergic reactions or if their
with dose adjustments.
(widening of blood as a runny or itchy nose, symptoms persist despite
The drug may
vessels) and increased sneezing, and Serious adverse effects treatment. Evaluate
accumulate in the body,
vascular permeability, congestion, which are such as severe allergic the therapeutic response by
leading to potential
which are responsible caused by histamine reactions, liver damage, assessing whether the
toxicity.
for fluid leakage into release in the nasal or heart-related issues patient’s allergy symptoms
tissues, causing passages. are rare but require (such as sneezing, itching, or
swelling and immediate medical nasal congestion) have been
It helps reduce Pregnancy (Category attention. Toxic
inflammation. Unlike reduced.
itching, redness, C): reactions, especially in
first-generation
and watering of the case of overdose or PATIENT/FAMILY TEACHING
antihistamines,
the eyes, Pregnant women: renal impairment, can
cetirizine is designed to
common in Cetirizine is classified as lead to severe  Take cetirizine as
have minimal sedative
effects, as it does not allergic Category C by the FDA, drowsiness, prescribed, usually
significantly cross the conjunctivitis. meaning it should only tachycardia, or once daily. The typical
blood-brain barrier. be used during convulsions. adult dose is 10 mg,
This makes it effective Skin: Cetirizine is also pregnancy if the but it may be adjusted
for treating allergies used to relieve itching, potential benefits based on your health
without the drowsiness hives, and swelling in outweigh the risks. It's condition (such as
often associated with the skin, as seen in not a first-line treatment kidney or liver
older antihistamines. chronic urticaria (hives), during pregnancy, problems).
by blocking histamine’s especially in the first  You can take cetirizine
Absorption: effects on skin cells. trimester. with or without food,
but it’s important to
Cetirizine is rapidly Breastfeeding: take it at the same
absorbed in the Lactating women: time every day to help
gastrointestinal tract Cetirizine is excreted establish a routine
after oral into breast milk in small  If you miss a dose,
administration. Peak amounts, so it should be take it as soon as you
plasma concentrations used cautiously in remember, but if it's
are typically reached breastfeeding mothers. almost time for your
within 1–2 hours If necessary, a next dose, skip the
following ingestion. healthcare provider may missed dose—do not
suggest an alternative take two doses at
The bioavailability of
treatment to avoid any once.
cetirizine is about 70-
potential effect on the
75%, meaning that a
infant.
significant portion of
the drug reaches the Children Under 2
bloodstream and can Years:
exert its effect. Infants younger than 2
years: Cetirizine should
Distribution: Cetirizine
be used with caution or
has a high protein
avoided in children
binding rate (~93%)
under 2 years due to
and is widely
potential side effects
distributed throughout
and the limited safety
the body. It crosses the
data available for this
blood-brain barrier to
 a limited extent, age group.
leading to reduced
sedation compared to
first-generation
antihistamines.

Metabolism: Cetirizine
is only minimally
metabolized in the
liver, primarily via the
enzyme CYP3A4
(which is responsible
for metabolizing many
drugs). Only a small
fraction is converted
into an inactive
metabolite,
desmethylcetirizine.

Excretion: The
majority of cetirizine is
excreted unchanged in
the urine.
Approximately 60% of
the dose is excreted via
the kidneys, with the
rest (around 10–15%)
eliminated through
feces.

Drug Name Dosage/ Mechanism of action Indication Contraindication Side /Adverse Effect Nursing Responsibility
Frequency/ Route

Generic Name: PO: Diphenhydramine is a Indicated for use in Hypersensitivity/ Frequent: Drowsiness, BASELINE ASSESSMENT:
Diphenhydrami first-generation treating Allergy to dry Mouth, dizziness,
ne Adults (for antihistamine that Diphenhydramine: headache, Obtain CBC, renal function
Brand Name: allergies): 25–50 works by blocking the  Sneezing Contraindicated in constipation, blurred test. Liver function test
Acetadryl, Advil mg every 4-6 H1 histamine  runny nose individuals who have a Vision, nausea or history of allergies,
PM, Aleve PM, hours, not receptors in the body.  itchy/watery known Upset Stomach particularly
Allegra Cooling exceeding 300 mg Histamine, a chemical eyes hypersensitivity or diphenhydramine or any
Relief Anti-itch, daily. released during  itching of nose allergic reaction to Occasional: Urinary ingredients in
Banophen, allergic reactions, or throat diphenhydramine or Retention, rapid Heart diphenhydramine
Benadryl, Children (6–12 binds to these  Insomnia any of its ingredients. Rate (Tachycardia),
Benadryl Itch years): 12.5–25 mg receptors and causes  pruritis, This could lead to confusion or Memory INTERVENTION/
Stopping, every 4-6 hours, symptoms such as  urticaria, serious allergic Problems, blurred EVALUATION:
Benadryl-D not exceeding 150 itching, swelling, and insect reactions like rashes, Vision, restlessness or
mg daily. Nervousness, Educate the patient on
Allergy and inflammation. By bites/stings, swelling, or difficulty
difficulty, skin Rash or correct usage, and monitor
Sinus, Calagel, preventing histamine  allergic rashes, breathing.
Children (2–6 Itching for side effects, particularly
Damylin With from binding to these  nausea
years): 12.5 mg Severe Liver Disease: sedation and anticholinergic
Codeine, etc. receptors, effectively
every 4-6 hours, Nervous System: People with severe Rare: Severe Allergic effects
reduces common
Classification: not exceeding 75 Relieves insomnia by liver disease should Reactions Assess effectiveness based
allergic symptoms
H1 receptor mg daily. acting as a sedative, avoid (Anaphylaxis), seizure, on symptom improvement
like sneezing.
Antihistamine diphenhydramine diphenhydramine, as coma, hallucinations (e.g., reduction in allergy
Absorption: The drug helps with sleep the liver is responsible or delirium, cardiac symptoms or improved
Clinical: is absorbed from the disturbances and for metabolizing the arrhythmias, severe sleep quality)
Antihistamines gastrointestinal (GI) relieves motion drug. Impaired liver dizziness or loss of Regularly monitor for
tract, and its sickness symptoms: function can lead to coordination, liver adverse effects like sedation,
bioavailability is Diphenhydramine can increased drug levels damage dry mouth, blurred vision,
approximately 40- help alleviate nausea, in the body, increasing and urinary retention.
60% due to first-pass vomiting, and the risk of side effects.
Adjust treatment based on
metabolism in the dizziness associated
Severe Renal the patient's response, side
liver. Food does not with motion sickness
Impairment: effects, and any changes in
significantly affect the by blocking histamine
Individuals with their health status (e.g.,
absorption of receptors in the brain
severe kidney renal or hepatic function).
diphenhydramine, so that are involved in
it can be taken with the vomiting reflex. impairment should
or without food. use diphenhydramine
Immune System: with caution or avoid
Metabolism: Relieves allergic it because the drug is
Diphenhydramine is reactions, often used excreted primarily by
 extensively for symptoms of hay the kidneys. If kidney
metabolized in the fever, seasonal function is
liver by the allergies, and other compromised, the PATIENT/FAMILY
cytochrome P450 allergic conditions. drug could accumulate TEACHING:
enzyme system, in the body, leading to
Respiratory System:  Do not exceed the
specifically by toxicity.
recommended dose
CYP2D6. This process
Relieves nasal Acute Asthma or  Swallow tablets with
converts
congestion and runny Respiratory Distress: a full glass of water
diphenhydramine
nose associated with Diphenhydramine  Avoid consuming
into inactive
allergic rhinitis should not be used to alcohol while taking
metabolites.
(seasonal allergies) by treat acute asthma diphenhydramine
Excretion:Diphenhyd blocking the effects of attacks or severe
ramine is primarily histamine on nasal respiratory distress as
excreted in the urine tissues. Relieves cough it can have a drying
as metabolites, with and sneezing. effect on mucus,
less than 1% of the potentially making it
drug being excreted harder to clear
unchanged. secretions and worsen
the condition.

Prepared by: Clinical Instructor: