Drug name: Action: Indication: Contra-indication Adverse reaction: Nursing

Intervention
Streptomycin Binds to 30S Intramusc Pregnancy, Giddiness, vertigo, • Draw blood
ribosomal sub ular hypersensitivity tinnitus, ataxia, for peak level
unit, inhibiting Tuberculo hypersensitivity 1 hour I.M
protein sis reactions, injection.
synthesis in Adult: 15 ototoxicity and • Monitor liver
bacterial cell, mg/kg nephrotoxicity. and kidney
which causes daily; max: Potentially Fatal: function
mis reading of 1 g daily. Anaphylactic shock, tests, watch
genetic cosd Reduce aplastic anaemia for evidence
and ultimately max daily and agranulocytosis. of
cell deathe. dose to Stevens-Johnson hepatotoxicit
500-750 syndrome and toxic y and
mg in epidermal nephrotoxicit
patients necrolysis. y
>40 yr. As • Monitor
part of an temp. stay
intermitten alert for
t therapy: fever and
25-30 other s/s of
mg/kg/day super
2-3 infection
times/wk; • Assess
max: 1.5 neurologic
g/dose. status and
Not >120 sensory
g over the function
course of carefully
treatment watch closely
should be for
given neurotoxixity
unless , seizures
there are • Monitor CBC,
no other watch for
treatment evidence of
options. blood
Child: 20– dyscrasias
40 mg/kg
(max: 1 g)
daily or
25–30
mg/kg
(max: 1.5
g) 2–3
times
wkly.
Elderly:
≥60 kg:
Dosage
reduction
is required.

Renal
impairme
nt:
Modificatio
n in dose
or dosing
interval
may be
required
Drug name: Action: Indication: Contra-indication: Adverse reaction: Nursing
intervention:
Tetracycline To inhibit To reduce the Pregnancy, Gastrointestina • Monitor for
bacterial protein development of hypersensitivity l: anorexia, s/s of super
synthesis at level drug-resistant epigastric infection
or 30S and 50S bacteria and distress, nausea, and
bacterial maintain the vomiting, hypersensi
ribosomes and to effectiveness of diarrhea, bulky tivity
loose stools,
alter cytoplasmic Sumycin ‘250’ reaction.
stomatitis, sore
membrane of and Sumycin throat, glossitis, • With long-
susceptible ‘500’ Tablets black hairy term use,
organisms. (Tetracycline tongue, monitor
Hydrochloride dysphagia, CBC, liver
Tablets) and hoarseness, function
other enterocolitis, and tests, and
inflammatory
antibacterial bone
lesions (with
drugs, Sum- ycin candidal growth
‘250’ and overgrowth) in • Assess
Sumycin ‘500’ the anogenital neurologic
Tablets region, including status,
(Tetracycline proctitis and stay alert
pruritus ani. Rare
Hydrochloride instances of fir benign
Tablets) should esophagitis and intra
be used only to esophageal cranial
treat or prevent ulceration have hypertensi
infections that been reported in on
are proven or patients receiving
particularly the
strongly
capsule and also
suspected to be the tablet forms
caused by of tetracyclines.
susceptible Most of the
bacteria. When patients were
culture and reported to have
susceptibility medication
immediately
information are
before going to
available, they bed. These
should be reactions have
considered in been caused by
selecting or both the oral and
modifying parenteral
administration of
antibacterial
tetracyclines but
therapy. In the are less frequent
absence of such after parenteral
data, local use.
epidemiology and Skin and Skin
susceptibility Structures:
patterns may maculopapular
contribute to the and
empiric selection erythematous
of therapy. rashes.
Exfoliative
dermatitis has
been reported
but is uncommon.
Onycholysis and
discoloration of
the nails have
been reported
rarely.
Photosensitivity
has occurred.
Renal Toxicity:
increases in BUN
have been
reported and are
apparently dose-
related.

Hepatic
Cholestasis: has
been reported
rarely, and is
usually
associated with
high dosage
levels of
tetracycline.
Hypersensitivit
y Reactions:
Anaphylaxis;
serum sickness-
like reactions, as
fever, rash, and
arthralgia;
urticaria,
angioneurotic
edema,
anaphylactoid
purpura,
pericarditis,
exacerbation of
systemic lupus
erythematosus.
Hematological:
Blood: anemia,
hemolytic
anemia,
thrombocytopeni
a,
thrombocytopeni
c purpura,
neutropenia and
eosinophilia have
been reported.
Miscellaneous:
Dizziness and
headache have
been reported.
When given over
prolonged
periods,
tetracyclines
have been
reported to
produce brown-
black microscopic
discoloration of
thyroid glands.
No abnormalities
of thyroid
function are
known to occur.
Bulging fontanels
in infants and
intracranial
hypertension in
adults have been
reported.
Drug name: Action Indication Contra-Indication Adverse Reaction Nursing
Intervention:
Vitamin k Phytonadione is Hypersensitivity Pregnancy:
used in the to vitamin K. Inadequate
prevention and Severe reactions, information exists
treatment of including as to whether
hypoprothrombin fatalities, have vitamin K may
emia caused by occurred during affect fertility in
vitamin K and immediately human males or
deficiency, oral after i.v. females or have a
anticoagulants, or phytonadione teratogenic
other factors injection even potential or other
which impair the when precautions adverse effect on
absorption or have been taken the fetus. Large
synthesis of to dilute the amounts of
vitamin K. phytonadione vitamin K in
Phytonadione is solution and to pregnancy,
also used in the avoid rapid however, can
prevention and infusion. These cause jaundice in
treatment of severe reactions, the newborn.
hemorrhagic which may occur
disease of the in patients
newborn. receiving
phytonadione for
Phytonadione the first time,
may have a role resemble
in restoring hypersensitivity
normal clotting or anaphylaxis,
time in patients including shock
with and cardiac or
hypoprothrombin respiratory arrest.
emia induced by Therefore, use of
 salicylates, the i.v. route
sulfonamides, should be
quinidine, quinine restricted to
or broad- those situations
spectrum where other
antibiotics, when routes are not
interference with feasible and the
vitamin K activity serious risk
is clearly the involved is
cause. considered
justified.

Drug name: Action: Indication Contra-Indication Adverse reaction: Nursing

intervention
thalidomide Suppresses a hypnosedative Due to its known The most serious • Monitoring
excess levels of effect, several human toxicity for s/s of
tumor necrosis mmune- teratogenicity, associated with hypersensiti
factor-alpha in modulatory even following a thalidomide is its vity
pt. with erythmia properties and an single dose, documented reaction.
nodosum anti-angiogenic thalidomide is human • Watch for
contraindicated
leprosum (ENL), action. teratogenicity..) and report
in pregnant
alters leukocyte Thalidomide has women and The risk of s/s of
migration by been used in women capable severe birth periphreral
changing cell several of becoming defects, primarily neuropathy
surface cutaneous pregnant. When phocomelia or • Assess CBC
characterictics inflammatory there is no death to the with white
disorders (such alternative fetus, is cell
treatment,
as erythema extremely high differential
women of
nodosum childbearing during the critical • Monitor
leprosum in potential may be period of reproductiv
lepromatous treated with pregnancy. The e status
leprosy, thalidomide critical period is
cutaneous lupus provided estimated,
adequate
erythematosus, depending on the
precautions are
severe aphtosis), taken to avoid source of
cancers pregnancy. information, to
(relapsed/refract Women must range from 35 to
ory multiple commit either to 50 days after the
myeloma) and abstain last menstrual
inflammatory continuously period. The risk
from
conditions. of other
heterosexual
Several side sexual contact or potentially
effects are to use two severe birth
associated with methods of defects outside
thalidomide: reliable birth this critical
control, including
teratogenicity, at least one period is
peripheral highly effective unknown, but
neuropathy and method (e.g., may be
deep venous IUD, hormonal significant. Based
thrombosis; contraception, on present
some are minor, tubal ligation, or knowledge,
partner’s
such as thalidomide must
vasectomy) and
somnolence or one additional not be used at
abdominal pain effective method any time during
and (e.g., latex pregnancy.
endocrinologic condom,
disturbances. Use diaphragm, or
of thalidomide is cervical cap),
beginning 4
strictly controlled
weeks prior to
with close initiating
adherence to a treatment with
birth control thalidomide,
program and during therapy
close monitoring with thalidomide,
and continuing
for early
for 4 weeks
development of following
peripheral discontinuation
neuropathy. of thalidomide
therapy. If
hormonal or IUD
contraception is
medically
contraindicated
Two other
effective or
highly effective
methods may be
 used.

Drug name Action Indication Contra-indication Adverse reaction Nursing

Intervention
steroids Decreases Steroids is 1. Male Hepatic: • Monitor
inflammation by indicated patients Cholestatic weight,
revearsing prophylactically with jaundice with, blood
increased cell to decrease the carcinoma rarely, hepatic pressure,
capillary frequency and of the necrosis and and
permeability and severity of breast, or death. electrolyte
inhibiting attacks of with known Hepatocellular level
migration of angioedema or neoplasms and • Watch for
polymorphonucle suspected peliosis hepatis s/s of
ar leukocytes, carcinoma have been depression
suppresses of the reported in and
immune system prostate. association with psychosis
by reducing long-term • Assess
lymphatic activity 2. Carcinoma androgenic- blood
of the anabolic steroid glucose
breast in therapy level-
females Reversible carefully in
with changes in liver diabetic pt.
hypercalce function tests • Monitor
mia; also occur for s/s of
androgenic including infection,
anabolic increased which drug
steroids bromsulphalein may mask
may (BSP) retention or
stimulate and increases in exacerbate
osteolytic serum bilirubin, .
resorption glutamic • Assess for
of bone. oxaloacetic early
3. Nephrosis transaminase indications
or the (SGOT), and or adrenal
nephrotic alkaline insufficienc
 phase of phosphatase. y.
nephritis. • Monitor
muscuskel
4. WINSTROL etal status
can cause for joint,
fetal harm tendon,
when and muscle
administere pain.
d to a
pregnant
woman.
WINSTROL is
contraindicated in
women who are
or may become
pregnant. If this
drug is used
during pregnancy,
or if the patient
becomes
pregnant while
taking this drug,
the patient should
be apprised of the
potential hazard
to the fetus.
Drug name: Action Indication Contra-indication Adverse Reaction Nursing
Intervention:
Lithium To disrupt sodium ESKALITH (lithium No information The occurrence • Obtain
exchange and carbonate) is provided. and severity of baseline
transport in indicated in the adverse reactions ECG and
nerves and treatment of are generally electrolyte
muscles and manic episodes directly related to level
control reuptake of manic- serum lithium before
depressive concentrations as
of periodically
illness. well as to
neurotransmitters Maintenance individual patient during
therapy prevents sensitivity to therapy
or diminishes the lithium, and • Assess
intensity of generally occur neurologic
subsequent more frequently and
episodes in those and with greater psychiatric
manic-depressive severity at higher
status
patients with a concentrations.
history of mania. • Monitor
Adverse reactions
lithium
Typical may be
encountered at blood level,
symptoms of
serum lithium WBC count
mania include levels below 1.5 • Assess
pressure of mEq/L. Mild to cardiovasc
speech, motor moderate ular status
hyperactivity, adverse reactions regularly
reduced need for may occur at • Monitor
sleep, flight of levels from 1.5 to fluid intake
2.5 mEq/L, and
ideas, and output
moderate to
grandiosity, severe reactions
elation, poor may be seen at
judgment, levels of 2.0
aggressiveness mEq/L and above
and possibly
hostility. When
given to a patient
experiencing a
manic episode,
ESKALITH may
produce a
normalization of
symptomatology
within 1 to 3
weeks.
Drug name: Action: Indication: Contra indication Adverse reaction Nursing intervention
dilantin The mechanism Dilantin is Phenytoin is Central Nervous • Continuously
of action is not indicated for the contraindicated System: The monitor vital
definitely known, control of in those patients most common signs and
but extensive generalized who are manifestations
encountered with symptoms
research tonic-clonic hypersensitive to
phenytoin during IV
strongly (grand mal) and phenytoin or
therapy are infusion and for
suggests that its complex partial other
referable to this an hour
main mechanism (psychomotor, hydantoins. system and are
is to block temporal lobe) afterward.
usually dose-
frequency-, use- seizures and related. These Watch for
and voltage- prevention and include respiratory
dependent treatment of nystagmus, depression.
neuronal sodium seizures ataxia, slurred Constant
speech, observation and
channels, and occurring during
decreased
therefore limit or following a cardiac
coordination, and
repetitive firing neurosurgery. mental confusion. monitor are
of action Dizziness, necessary with
potentials. insomnia, older adults or
transient patients with
nervousness,
cardiac disease.
motor twitchings,
and headaches Margin between
have also been toxic and
observed. There therapeutic IV
have also been
rare reports of doses is
phenytoin- relatively small.
induced • Be aware of
dyskinesias,
including chorea, therapeutic
dystonia, tremor, serum
and asterixis, concentration:
similar to those 10–20 mcg/mL;
induced by toxic level: 30–
phenothiazine
and other
50 mcg/mL;
neuroleptic lethal level: 100
drugs. mcg/mL.
Gastrointestinal Steady-state
System: Nausea, therapeutic
vomiting, levels are not
constipation, achieved for at
toxic hepatitis,
least 7–10 d.
and liver
damage. • Lab tests:
Integumentary Periodic serum
System: phenytoin
Dermatological concentration;
manifestations
CBC with
sometimes
accompanied by differential,
fever have platelet count,
included and Hct and
scarlatiniform or Hgb; serum
morbilliform glucose, serum
rashes. A
morbilliform rash calcium, and
(measles-like) is serum
the most magnesium; and
common; other
types of liver funtion
dermatitis are tests.
seen more rarely. • Observe patient
Other more
serious forms closely for
which may be neurologic
fatal have adverse effects
included bullous, following IV
exfoliative or administration.
purpuric
dermatitis, lupus
Have on hand
erythematosus, oxygen,
Stevens-Johnson atropine,
syndrome, and vasopressor,
toxic epidermal assisted
necrolysis
ventilation,
Hemopoietic
System: seizure
Hemopoietic precaution
complications, equipment
some fatal, have (mouth gag,
occasionally been
nonmetal
reported in
association with airway, suction
administration of apparatus).
phenytoin. These • Be aware that
have included
thrombocytopeni gingival
a, leukopenia, hyperplasia
granulocytopenia appears most
, agranulocytosis, commonly in
and
pancytopenia children and
with or without adolescents and
bone marrow never occurs in
suppression.
While patients without
macrocytosis and teeth.
megaloblastic • Make sure
anemia have
occurred, these patients on
conditions prolonged
usually respond therapy have
to folic acid adequate intake
therapy. of vitamin D-
Lymphadenopath
y including
containing foods
benign lymph and sufficient
node hyperplasia, exposure to
pseudolymphoma sunlight.
, lymphoma, and
Hodgkin's • Monitor
disease have diabetics for loss
been reported of glycemic
Connective control.
Tissue System:
Coarsening of the • Check
facial features, periodically for
enlargement of decrease in
the lips, gingival serum calcium
hyperplasia,
hypertrichosis, levels.
and Peyronie's Particularly
disease. susceptible:
Immunologic: patients
Hypersensitivity receiving other
syndrome (which anticonvulsants
may include, but concurrently, as
is not limited to, well as those
symptoms such who are inactive,
as arthralgias,
eosinophilia, have limited
fever, liver exposure to sun,
dysfunction, or whose dietary
lymphadenopath intake is
y, or rash), inadequate.
systemic lupus
erythematosus, • Observe for
periarteritis symptoms of
nodosa and folic acid
immunoglobulin
abnormalities.
deficiency:
neuropathy,
mental
dysfunction.
• Be alert to
symptoms of
hypomagnesemi
a (see Appendix
F);
neuromuscular
symptoms:
tetany, positive
Chvostek’s and
Trousseau’s
signs, seizures,
tremors, ataxia,
vertigo,
nystagmus,
muscular
fasciculations.