DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES

CONTRAINDICATION
GENERIC: Binds to intracellular glucocorticoid INDICATION/s: CNS: BEFORE
PREDNISOLONE receptors and suppresses To treat adrenal insufficiency and Euphoria, headache, insomnia,
inflammatory and acute and chronic inflammatory and nervousness, psychosis, restlessness, Dx:
BRAND: PRELONE immune responses by: immunosuppressive disorders seizures, vertigo a. Check for allergies

THERAPEUTIC: • inhibiting neutrophil and monocyte To treat acute exacerbations of CV: b. Assess patient regularly for
IMMUNOSUPPRESSANT accumulation at inflammation site multiple sclerosis Edema, heart failure, hypertension evidence of such reactions,
and suppressing their phagocytic and including heart failure and
PHARMACOLOGIC: bactericidal activity To treat uncontrolled asthma in EENT: hypertension
GLUCOCORTICOID children taking inhaled Cataracts, exophthalmos, glaucoma,
• stabilizing lysosomal membranes corticosteroids increased ocular pressure c. Monitor patient’s intake,
DOSAGE: 1.06 mkD and long-acting bronchodilators output, and daily weight
ROUTE: ORAL • suppressing antigen response of ENDO:
macrophages and helper T cells To treat pediatric nephrotic Adrenal insufficiency, Cushing’s Tx:
syndrome syndrome, growth suppression in a. Give once-daily doses in the
• inhibiting synthesis of children, hyperglycemia morning to mirror body’s normal
inflammatory response mediators, cortisol secretion.
such as cytokines, interleukins, and CONTRAINDICATION/s:
GI:
prostaglandins. Hypersensitivity to prednisolone or b. Perform a thorough physical
Anorexia, GI bleeding and ulceration,
its components, idiopathic assessment to establish baseline
increased appetite, indigestion,
SOURCE: Jones & Bartlett thrombocytopenic data before drug therapy begins
intestinal perforation, nausea,
Learning (2021) Nurse’s Drug purpura (I.M. form), systemic fungal
pancreatitis, vomiting
Handbook infection c. Restrict amount of drug
available to patient.
GU:
DRUG TO DRUG
Menstrual irregularities
INTERACTION: EDx:
aminoglutethimide: Possibly loss of a. Instruct patient to take oral
induced adrenal suppression MS: prednisolone with food to decrease
amphotericin B, diuretics: Possibly Avascular necrosis of joints, bone stomach upset and to take once-
severe hypokalemia fractures, muscle atrophy or weakness, daily dose in the morning.
antacids, cholestyramine, colestipol: myalgia, osteoporosis, tendon rupture
Decreased prednisolone absorption (local injection only) b. Emphasize need to take drug
anticholinesterase agents: Possibly exactly as prescribed, taking too
severe weakness in patients with SKIN: much increases risk of serious
myasthenia Acne; cutaneous or subcutaneous adverse reactions.
gravis. atrophy (with frequent repository
barbiturates, phenytoin, rifampin: injections); diaphoresis; ecchymosis; c. Instruct patient taking orally
Decreased prednisolone effects flushing; petechiae; striae; thin, fragile disintegrating tablets to remove
cyclosporine: Increased risk of skin tablet from blister pack only when
seizures ready to take drug and to place
digoxin: Possibly arrhythmias and OTHERS: tablet on tongue. Warn her not to
digitalis toxicity from hypokalemia Delayed wound healing, break, cut, or split tablets.
estrogens, oral contraceptives: hypernatremia, hypokalemia, injection-
Decreased clearance, increased site DURING
elimination half-life, and increased scarring, negative nitrogen balance
therapeutic and toxic effects of Dx:
prednisolone a. Monitor for adverse effects
insulin, oral antidiabetics: Increased such as heart failure or hypertension
risk of hyperglycemia
ketoconazole, macrolide antibiotics: b. Check for drug to drug or drug
Possibly decreased prednisolone to food interactions
metabolism
isoniazid, salicylates: Decreased c. Monitor the patient’s intake,
blood level of these drugs output, and daily intake
live or inactivated vaccines, toxoids:
Possibly diminished response to Tx:
vaccines a. Assist patient in taking the
or toxoids medication
NSAIDs: Increased risk of GI
ulceration and bleeding, possibly b. Keep in mind that prednisolone
added can produce many adverse reactions
therapeutic effect when NSAIDs are so take safety precautions.
used to treat arthritis
warfarin: Possibly inhibition of c. Limit assess to drug if patient
warfarin effect is experiencing adverse effects to
reduce harm.
DRUG TO FOOD
INTERACTION: EDx:
sodium-containing foods: Increased
risk of edema and hypertension a. Instruct patient to avoid
alcohol during therapy because of
increased risk of GI ulcers and
bleeding.

b. Instruct patient to avoid

hazardous activities until drug’s
CNS effects are known.

c. Advise patient to avoid people

with contagious infections because
drug has an immunosuppressant
effect. Instruct her to notify
prescriber immediately about
exposure to measles or chickenpox.

AFTER

Dx:
a. Monitor growth pattern in
children; prednisolone may retard
bone growth.

b. Monitor patient’s intake,

output, and daily weight.

c. Monitor for side effects

Tx:
a. Provide safety measures (e.g.,
adequate lighting, raised side rails,
etc.) to prevent injuries.

b. Keep in mind that prednisolone

 can produce many adverse reactions
so take safety precautions.

c. Prolonged use may cause

hypothalamic-pituitary-adrenal
suppression.

EDx:
a. Advise patient to comply with
follow-up visits to assess drug’s
effectiveness and detect adverse
reactions.

b. Instruct patient to notify

prescriber immediately about joint
pain, swelling, tarry stools, and
visual disturbances. Also instruct
her to report signs of infection or
injury for up to 12 months after
therapy.

c. Instruct diabetic patient to

check her blood glucose level often
because prednisolone may cause
hyperglycemia.

DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES

CONTRAINDICATION
GENERIC: RIFAMPIN Inhibits bacterial and mycobacterial INDICATION/s: CNS: BEFORE
(RIFAMPICIN) RNA synthesis by binding to DNA As adjunct to treat tuberculosis Ataxia, behavioral changes, chills, Dx:
dependent caused by all strains of confusion, difficulty concentrating, a. Monitor patient for signs and
BRAND: RIMACTANE RNA polymerase, thereby blocking Mycobacterium dizziness, drowsiness, fatigue, fever, symptoms of hypersensitivity reactions
RNA transcription. Exhibits dose Tuberculosis generalized numbness, headache,
THERAPEUTIC: dependent paresthesia, psychoses b. Monitor patient for rash or other
ANTIMYCOBACTERIAL bactericidal or bacteriostatic action. To eliminate meningococci from skin abnormalities
ANTITUBECULAR Rifampin is highly effective nasopharynx of asymptomatic CV:
against rapidly dividing bacilli in carriers of Neisseria meningitidis Hypotension, myopathy, vasculitis c. Check for allergies before
extracellular cavitary lesions, such administering the drug
PHARMACOLOGIC: as those CONTRAINDICATION/s: EENT:
SEMISYNTHETIC found in the nasopharynx. Concurrent use of atazanavir, Conjunctivitis; discolored saliva, Tx:
RIFAMYCIN darunavir, fosamprenavir, sputum, tears, and teeth; mouth or a. Check if it the right drug and the
SOURCE: Jones & Bartlett praziquantel, tongue soreness; periorbital edema; right patient
Learning (2021) Nurse’s Drug ritonavir/saquinavir, saquinavir, or visual disturbances
DOSAGE: 15 mkD Handbook tipranavir; hypersensitivity to b. Obtain blood samples or other
ROUTE: ORAL rifampin, other rifamycins or their ENDO: specimens for culture and sensitivity
components Adrenal insufficiency (rare), testing, as ordered, before giving
hyperglycemia or hypoglycemia (in rifampin and throughout therapy to
DRUG TO DRUG patients with diabetes) monitor response to drug
INTERACTION:
antacids: Possibly reduced rifampin c. Perform a thorough physical
GI:
absorption assessment to establish baseline data
Abdominal cramps, anorexia,
antiarrhythmics (disopyramide, before drug therapy begins
cholestasis, diarrhea, discolored
mexiletine, quinidine, propafenone,
feces, elevated liver enzymes,
tocainide), EDx:
epigastric discomfort, flatulence,
anticonvulsants (phenytoin), a. Instruct patient to take rifampin 1
heartburn, hepatitis, jaundice, nausea,
antiestrogens (tamoxifen, hour before or 2 hours after a meal with
pseudomembranous colitis, shock-
toremifene), antifungals a full glass of water.
like syndrome with
(fluconazole, itraconazole,
hepatic involvement, vomiting
ketoconazole), antipsychotics b. Emphasize the need to take drug
(haloperidol), exactly as prescribed. Explain that not
GU:
antiretrovirals (atazanavir, completing the full course of therapy or
Acute renal failure or tubular
darunavir, efavirenz, skipping doses may decrease the
necrosis, discolored urine, elevated
fosamprenavir, indinavir, effectiveness of the treatment and
BUN and serum uric acid, hematuria,
saquinavir, tipranavir, zidovudine), interstitial nephritis, menstrual increase the chance that resistance to
benzodiazepines (diazepam), disturbances, renal insufficiency drug may develop, making it
benzodiazepine-related drugs ineffective to treat an infection patient
(zopiclone, zolpidem), beta HEME: might develop in the future. Emphasize
blockers (metoprolol, Agranulocytosis (rare), decreased importance of compliance with the full
propranolol), calcium channel hemoglobin, disseminated course of therapy.
blockers (diltiazem, nifedipine, intravascular coagulation (DIC),
verapamil), eosinophilia, hemolytic anemia, c. Explain that drug may discolor
chloramphenicol, clarithromycin, leukopenia, feces, saliva, skin, sputum, sweat, tears,
corticosteroids (prednisolone), neutropenia, purpura, teeth, and urine reddish brown to
dapsone, thrombocytopenia (rare) reddish orange or yellow. Discoloration
digoxin, doxycycline, enalapril, MS: Arthralgia, extremity pain, of teeth and soft contact lenses may be
fluoroquinolones (moxifloxacin, muscle weakness, myalgia (rare) permanent.
perfloxacin),
hepatitis C antiviral (daclatasvir, RESP: DURING
simeprevir, sofosbuvir, telaprevir), Acute bronchospasm, shortness of
hypoglycemic agents oral breath, wheezing Dx:
(glipizide, glyburide), a. Monitor patient’s signs and
immunosuppressive agents SKIN: symptoms for reactions.
(cyclosporine, tacrolimus), Acute generalized exanthematous
irinotecan, levothyroxine, losartan, pustulosis, discolored skin and sweat, b. Check for drug to drug or drug to
methadone, erythema multiforme, flushing, food interactions.
narcotic analgesics (morphine, pemphigoid reaction, pruritus, rash,
oxycodone), praziquantel, quinine, Stevens–Johnson syndrome, toxic c. Monitor patient’s skin for
selective 5- epidermal necrolysis, urticaria abnormalities that can be life-
HT3 receptor antagonists threatening
(ondansetron), statins (simvastatin), Other:
systemic Anaphylaxis, angioedema, drug Tx:
hormonal contraceptives reaction with eosinophilia and a. Assist patient in taking the
(estrogens, progestins), systemic symptoms (DRESS), flu- medication
telithromycin, theophylline, like symptoms, lymphadenopathy
thiazolidinediones (rosiglitazone), b. Provide safety measures (e.g.,
tricyclic antidepressants adequate lighting, raised side rails, etc.)
(nortriptyline), to prevent injuries.
warfarin: Decreased exposure and
effectiveness of these drugs c. Provide supportive care to the
atovaquone: Decreased patient
concentration of atovaquone and
increased concentration EDx:
of rifampin, which may increase a. Advise patient who takes an oral
risk of toxicities contraceptive to use an additional form
cotrimoxazole, probenecid: of birth control during rifampin
Increased rifampin concentration therapy.
halothane, isoniazid: Possibly
hepatotoxicity b. Instruct patient to notify prescriber
ritonavir/saquinavir: Increased risk about anorexia, cough, darkened urine,
of severe hepatotoxicity fever, flu-like symptoms, joint pain or
swelling, malaise, nausea, rash,
DRUG TO FOOD shortness of breath, swollen lymph
INTERACTION: nodes, vomiting, wheezing, and
yellowish eyes or skin.

c. Advise patient to avoid alcohol,

herbal products, or any drug that
adversely affects the liver (without
prescriber consent) during rifampin
therapy.

AFTER

Dx:
a. Assess knowledge/teach patient
appropriate use of interventions to
reduce side effects, and adverse
symptoms to report

b. Monitor the effectiveness of the

drug exhibited by decrease in
symptoms
 c. Monitor patient for signs and
symptoms of hypersensitivity reactions

Tx:
a. Provide comfort measures to help
patient tolerate drug effects.

b. Monitor for adverse effects such as

generalized numbness, headache,
paresthesia, psychoses

c. Provide safety measures (e.g.

adequate lighting, raised side rails, etc.)
to prevent injuries.

EDx:
a. Instruct patient to notify prescriber
if no improvement occurs within 2 to 3
weeks.

b. Inform patient with diabetes

mellitus that rifampin therapy may
affect his blood glucose levels and to
monitor his blood glucose levels
closely.

c. Tell patient to inform all

prescribers of rifampin therapy.

d. Instruct patient to notify prescriber

immediately if rash or other skin
abnormalities occur, as reaction may
become severe.