Question

•Discuss the actions, side effects, contraindications and nursing considerations of the following medications:

• Ceftriaxone

o Vancomycin hydrochloride

o Fentanylcitrate

o Midazolam hydrochloride

o Diazepam

o Lidocaine/Prilocaine topical cream

Answer 1

Discuss the actions, side effects, contraindications and nursing considerations of the following medications:

• Ceftriaxone

o Vancomycin hydrochloride

o Fentanylcitrate

o Midazolam hydrochloride

o Diazepam

o Lidocaine/Prilocaine topical cream

DRUGS	Mechanism of action	Side effects	Contraindication	Nursing advice
Ceftriaxone	Ceftriaxone is a third-generation cephalosporin family of antibiotics. Ceftriaxone selectively and irreversibly inhibits bacterial cell wall synthesis by binding to transpeptidases, also called transamidases.	Eosinophilia,Thrombocytosis , Elevations in liver enzymes, Diarrhea, Leukopenia,Rash.	For those who are allergic to ceftriaxone	Always give test dose for this drug, Keep a look on LFT and rash
Vancomycin hydrochloride	Vancomycin acts by inhibiting proper cell wall synthesis in Gram-positive bacteria	local pain, which may be severe, and thrombophlebitis, Nephrotoxicity and Ototoxicity. Rare adverse effects are anaphylaxis, toxic epidermal necrolysis, erythema multiforme, red man syndrome,	Pregnancy, Hypersensitivity, Renal compromise patient.	Always give test dose for this drug. Keep a watch on local iv site pain.
Fentanylcitrate	It acts on G-protein-coupled opioid leading to decreased cAMP production leading to decreased calcium ion influx, and increased potassium efflux.This inhibits the ascending pathways in the central nervous system to increase pain threshold resulting in analgesic effects.	diarrhea, nausea, constipation, dry mouth, somnolence, confusion, asthenia (weakness), sweating	Known hypersensitivity, k/c/o acute asthama, paralytic ileus	Continuous vitals monitoring
Midazolam hydrochloride	It belongs to benzodiazepine group, it acts by acting on GABA receptor by facilitating Chloride influx	Tolerance, dependence, and withdrawal	elderly, during pregnancy, in children, in alcohol- or other drug-dependent individuals	Vitals monitoring, watch for respiratory distress,
Diazepam	Same as midazolam as both belongs to same group	Same as midazolam as both belongs to same group	Ataxia, Severe hypoventilation, Acute narrow-angle glaucoma, Severe hepatic deficiencies, Liver disorders, Severe sleep apnea, Psychosis, Pregnancy or breast feeding, Myasthenia gravis,	Vitals monitoring, watch for respiratory distress,
Lidocaine/Prilocaine topical cream	Lidocaine alters signal conduction in neurons by prolonging the inactivation of the fast voltage-gated Na+ channels in the neuronal cell membrane responsible for action potential propagation	Hypersensitivity Systemic reactions are CNS - nervousness, agitation, anxiety, apprehension, tingling around the mouth Cardiovascular - hypotension, bradycardia, arrhythmias, flushing, venous insufficiency, increased defibrillator threshold, edema, Respiratory - bronchospasm, dyspnea, respiratory depression or arrest Gastrointestinal: metallic taste, nausea, vomiting Ears: tinnitus Eyes: local burning, conjunctival hyperemia, corneal epithelial changes/ulceration, diplopia, visual changes Skin: itching, depigmentation, rash, urticaria, edema, angioedema, bruising, inflammation of the vein at the injection site, irritation of the skin when applied topically Blood: methemoglobinemia	Heart block, second or third degree Severe sinoatrial block Serious adverse drug reaction to lidocaine or amide local anesthetics Hypersensitivity to corn and corn-related products (corn-derived dextrose is used in the mixed injections)	Close vitals monitoring