Drug Name: Oxacillin SodiumClassification: ANTIINFECTIVE; ANTIBIOTIC PENICILLIN; ANTISTAPHYLOCOCCAL PENICILLINIndication: Primarily, infections caused by penicillinase-producing staphylococci and penicillin-resistant staphylococci. May be used to initiate therapy in suspected staphylococcal infections pending culture and sensitivity test results. As with other penicillins, serum concentrations are enhanced by concurrent use of probenecid.Drug Prep: 250 mg, 500 mg capsules; 250 mg/5 mL suspension; 250 mg, 500 mg, 1 g, 2 Neonate: IV 50100 mg/kg/d divided q612hChild: PO 50100 mg/kg/d in 4 divided doses IM/IV 50150 mg/kg/d divided q46hDilutions: Injection Direct: Reconstitute each 500 mg or fraction thereof with 5 mL with sterile water for injection or NS to yield 250 mg/1.5 mL. Intermittent: Further dilute in 50100 mL of D5W, NS, D5/NS, or RL. Continuous: Further dilute in up to 1000 mL of compatible IV solutions.Drug Interactions: INCOMPATIBILITIES Solution: additive: Cytarabine Y-site: Sodium bicarbonate, verapamil.

Contraindications: Hypersensitivity to penicillins or cephalosporins. Safe use during pregnancy (category B) is not established.Adverse Reactions: Body as a Whole: Thrombophlebitis (IV therapy), superinfections, wheezing, sneezing, fever, anaphylaxis. GI: Nausea, vomiting, flatulence, diarrhea, hepatocellular dysfunction (elevated AST, ALT, hepatitis). Hematologic: Eosinophilia, leukopenia, thrombocytopenia, granulocytopenia, agranulocytosis; neutropenia (reported in children). Skin: Pruritus, rash, urticaria. Urogenital: Interstitial nephritis, transient hematuria, albuminuria, azotemia (newborns and infants on high doses).Special Considerations: History of or suspected atopy or allergy (hives, eczema, hay fever, asthma); premature infants, neonates, lactation (may cause infant diarrhea).Nursing Responsibilities:Assessment & Drug EffectsAsk patient prior to first dose about hypersensitivity reactions to penicillins, cephalosporins, and other allergens.Lab tests: periodic liver functions, CBC with differential, platelet count, and urinalysis.Hepatic dysfunction (possibly a hypersensitivity reaction) has been associated with IV oxacillin; it is reversible with discontinuation of drug. Symptoms may resemble viral hepatitis or general signs of hypersensitivity and should be reported promptly: hives, rash, fever, nausea, vomiting, abdominal discomfort, anorexia, malaise, jaundice (with dark yellow to brown urine, light-colored or clay-colored stools, pruritus).Withhold next drug dose and report the onset of hypersensitivity reactions and superinfections (see Appendix F).Patient & Family EducationTake oral medication around the clock, do not miss a dose. Take all of the medication prescribed even if you feel better, unless otherwise directed by physician.Do not breast feed while taking this drug without consulting physician.

Drug Name: CeftazidimeClassification: ANTIINFECTIVE; ANTIBIOTIC; THIRD-GENERATION CEPHALOSPORINIndication: To treat infections of lower respiratory tract, skin and skin structures, urinary tract, bones and joints; also used to treat bacteremia, gynecological, intra-abdominal and CNS infections (including meningitis).Drug Prep: 500 mg, 1 g, 2 g injectionDilutions: Direct: Give over 35 min. Intermittent: Give over 3060 min. If given through a Y-type set, discontinue other solutions during infusion of ceftazidime.Drug Interactions: Drug: Probenecid decreases renal elimination of ceftazidine.Contraindications: Hypersensitivity to cephalosporins and related beta-lactam antibiotics; pregnancy (category B)Adverse Reactions: Body as a Whole: Fever, phlebitis, pain or inflammation at injection site, superinfections. GI: Nausea, vomiting, diarrhea, abdominal pain, metallic taste, drug-associated pseudomembranous colitis. Skin: Pruritus, rash, urticaria. Urogenital: Vaginitis, candidiasis.

Drug Name Nalbuphine HClClassification: CENTRAL NERVOUS SYSTEM AGENT; ANALGESIC; NARCOTIC (OPIATE) AGONIST-ANTAGONISTIndication: Symptomatic relief of moderate to severe pain. Also preoperative sedation analgesia and as a supplement to surgical anesthesia.Drug Prep: 10 mg/mL, 20 mg/mL injectionDilutions: History of hypersensitivity to drug. Safety during pregnancy (category C) or lactation is not established. Prolonged use during pregnancy could result in neonatal withdrawal.Drug Interactions: Drug: Alcohol and other CNS DEPRESSANTS add to CNS depressionContraindications: History of hypersensitivity to drug. Safety during pregnancy (category C) or lactation is not established. Prolonged use during pregnancy could result in neonatal withdrawal.Adverse Reactions: Note: Verify correct rate of IV injection in infants, children with physician.Special Considerations: History of emotional instability or drug abuse; head injury, increased intracranial pressure; impaired respirations; impaired kidney or liver function; MI; biliary tract surgery.Nursing Responsibilities:Assessment & Drug EffectsAssess respiratory rate before drug administration. Withhold drug and notify physician if respiratory rate falls below 12.Watch for allergic response in persons with sulfite sensitivity.Administer with caution to patients with hepatic or renal impairment.Monitor ambulatory patients; nalbuphine may produce drowsiness.Watch for respiratory depression of newborn if drug is used during labor and delivery.Avoid abrupt termination of nalbuphine following prolonged use, which may result in symptoms similar to narcotic withdrawal: nausea, vomiting, abdominal cramps, lacrimation, nasal congestion, piloerection, fever, restlessness, anxiety.

Patient & Family EducationDo not drive or engage in potentially hazardous activities until response to drug is known.Avoid alcohol and other CNS depressants.Do not breast feed while taking this drug without consulting physician.

Drug Name: ParacetamolClassification: CENTRAL NERVOUS SYSTEM AGENT; NONNARCOTIC ANALGESIC, ANTIPYRETICIndication: Fever reduction. Temporary relief of mild to moderate pain. Generally as substitute for aspirin when the latter is not tolerated or is contraindicated.Drug Prep: 80 mg, 120 mg, 125 mg, 300 mg, 325 mg, 650 mg suppositories; 80 mg, 160 mg, 325 mg, 500 mg tablets; 80 mg/0.8 mL, 80 mg/2.5 mL, 80 mg/5 mL, 120 mg/5 mL, 160 mg/5 mL, 500 mg/5 mL liquid

Dilutions:Drug Interactions: Drug: Cholestyramine may decrease acetaminophen absorption. With chronic coadministration, BARBITURATES, carbamazepine, phenytoin, and rifampin may increase potential for chronic hepatotoxicity. Chronic, excessive ingestion of alcohol will increase risk of hepatotoxicity.Contraindications: Hypersensitivity to acetaminophen or phenacetin; use with alcohol.Adverse Reactions: Body as a Whole: Negligible with recommended dosage; rash. Acute poisoning: Anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis, chills, epigastric or abdominal pain, diarrhea; onset of hepatotoxicityelevation of serum transaminases (ALT, AST) and bilirubin; hypoglycemia, hepatic coma, acute renal failure (rare). Chronic ingestion: Neutropenia, pancytopenia, leukopenia, thrombocytopenic purpura, hepatotoxicity in alcoholics, renal damage.Nursing Responsibilities: Assessment & Drug EffectsMonitor for S&S of: hepatotoxicity, even with moderate acetaminophen doses, especially in individuals with poor nutrition or who have ingested alcohol over prolonged periods; poisoning, usually from accidental ingestion or suicide attempts; potential abuse from psychological dependence (withdrawal has been associated with restless and excited responses).

Patient & Family EducationDo not take other medications (e.g., cold preparations) containing acetaminophen without medical advice; overdosing and chronic use can cause liver damage and other toxic effects.Do not self-medicate adults for pain more than 10 d (5 d in children) without consulting a physician.Do not use this medication without medical direction for: fever persisting longer than 3 d, fever over 39.5 C (103 F), or recurrent fever.Do not give children more than 5 doses in 24 h unless prescribed by physician.Do not breast feed while taking this drug without consulting physician.