Diagnosis: To consider septic shock secondary to community acquired pneumonia; high risk, Hepatitis A infection.

Date: April 29, 2025

Name of Drug Dosage/Frequency/ Mechanism of Action Indication Contraindication Adverse Effect Nursing Responsibilities
Timing/Route

Generic Name: Dosage: It works by acting as a N-Acetylcysteine Contraindicated in Gastrointestinal:

N-Acetyl Cysteine 600 mg/1 tablet mucolytic agent, (NAC) may be patients with a known Nausea, vomiting, ●​ Monitor vital signs,
(NAC) breaking down and indicated for this hypersensitivity to the diarrhea, abdominal particularly respiratory
thinning mucus in the patient primarily for drug and should be pain. rate and effort, as NAC
Brand Name: Frequency: airways to facilitate its mucolytic used with caution in can cause
Exflem OD easier expulsion. properties. Given the individuals with Respiratory: bronchospasm.
N-Acetyl Cysteine presence of secretions severe asthma, as it Bronchospasm ●​ Assess for symptoms of
Classifications: Timing: (NAC) also boosts the in the oral and may induce (especially in patients liver toxicity if used for
Mucolytic agent 8am production of endotracheal tubes, bronchospasm. with asthma or acetaminophen
glutathione, an NAC can help thin reactive airway overdose (e.g.,
Route: important antioxidant and break down disease), nasal jaundice, confusion).
NGT that protects cells mucus, making it congestion. ●​ Evaluate the patient’s
from oxidative stress, easier to clear and respiratory status
enhancing respiratory improving respiratory Integumentary: ●​ Administer NAC as
function in conditions function. Rash, pruritus ordered, ensuring the
with excessive mucus (itching), urticaria proper route (oral or
production. (hives). intravenous) and
dosage.
Reference: Neurological: ●​ Verify allergies and
Drowsiness, headache, contraindications (e.g.,
Tashkin, D. & Ghosh, dizziness. hypersensitivity, severe
K. (2020). asthma).
N-acetylcysteine: Hematological: ●​ Educate the folks about
Pharmacological Rare cases of the purpose of NAC
mechanisms and thrombocytopenia and its potential side
clinical applications. (low platelet count). effects.
Clinical ●​ Monitor any signs of
Pharmacology in allergic reactions or
Drug Development, respiratory distress.
9(6), 673-683. ●​ Observe for therapeutic
https://doi.org/10.1002 effects, such as
 /cpdd.824 improved respiratory
function or reduction in
liver enzyme levels.
●​ Monitor for adverse
effects, including
nausea, vomiting, or
bronchospasm.
●​ Document
administration details,
including dosage, time,
route, and any patient
responses or side
effects noted.

References:

Kizior, R., & Hodgson, K. (2021). Saunders Nursing Drug Handbook 2021. Elsevier.

Tashkin, D., & Ghosh, K. (2020). N-acetylcysteine: Pharmacological mechanisms and clinical applications. Clinical Pharmacology in Drug Development, 9(6), 673-683.
https://doi.org/10.1002/cpdd.824

Name of Drug Dosage/Frequency/ Mechanism of Action Indication Contraindication Adverse Effect Nursing Responsibilities
Timing/Route
Generic Name: Dosage:
Ursodeoxycholic 300 mg/1 tablet Ursodeoxycholic acid ●​ Treatment of ●​ Complete Gastrointestinal ●​ Assess baseline and
Acid reduces the cholesterol primary biliary System: periodic liver
content of bile by biliary obstruction Diarrhea, Nausea, function tests
Brand Name: Frequency: decreasing cholesterol cholangitis ●​ Radiopaque Vomiting, Abdominal (SGPT, SGOT, ALP,
UDCACID BID absorption and (PBC) (calcified) discomfort, bilirubin) prior to
secretion. It protects ●​ Dissolution of gallstones Constipation and during therapy.
Classifications: Timing: hepatocytes from small, ●​ Non-functioni ●​ Monitor for any
Bile Acid 8am, 6pm cytotoxic bile acids, radiolucent ng gallbladder Hepatic System: signs of worsening
Sequestrants stabilizes liver cell cholesterol ●​ Acute Elevated liver hepatic condition,
Route: membranes, and gallstones inflammation enzymes such as jaundice,
NGT improves bile flow, ●​ Off-label: of gallbladder (transaminases: SGPT, confusion, or
making it useful in Supportive or biliary tract SGOT), Potential increasing ascites,
treating cholestatic therapy for ●​ Known worsening of liver especially because
liver diseases. hepatitis to hypersensitivit disease if ineffective the patient has
reduce liver y to Hepatitis A and
Reference: damage ursodeoxychol Integumentary septic risk.
ic acid or any System: ●​ Evaluate
U.S. National Library of component of Pruritus (itching), gastrointestinal
Medicine. (2024). the product Rash tolerance, especially
Ursodiol. MedlinePlus. monitoring for
https://medlineplus.gov/ Neurological System: diarrhea or
druginfo/meds/a699036. Headache, Dizziness abdominal pain
html which may worsen
fluid imbalance in
septic shock
patients.
●​ Educate caregiver
about taking the
medication with
meals to improve
absorption and
minimize GI upset.
●​ Check current
medications for
potential drug
interactions,
 especially bile acid
sequestrants or
aluminum antacids,
which should be
spaced 2 hours apart
from UDCA.
●​ Administer the
medication exactly
as prescribed,
considering dose
adjustments based
on liver function and
overall clinical
condition.
●​ Document the
patient’s response to
therapy, side effects
experienced, and
laboratory trends
during treatment.

References:

U.S. National Library of Medicine. (2024). Ursodiol. MedlinePlus. https://medlineplus.gov/druginfo/meds/a699036.html

Lexicomp. (2024). Ursodiol: Drug information. UpToDate. https://www.uptodate.com/contents/ursodiol-drug-information