Generic Name: Cefixime Brand Name: Suprax Classification: Antiinfective, Antibiotic, 3rd Generation cephalosporin Indication: Effective against

S. pyogenes, S. pneumonia, & gram (-) bacilli, including Hamophilus influenza, Branhamella catarrhalis and N. gonorrheae. Little activity against Stpahylococci & no activity against Pseudomonas aeruginosa; also uncomplicated UTI, otitis media, pharyngitis, tonsillitis Mechanism of Action: Highly stable in the presence of beta-lactamases (penicillinases and cephalosporinases) and therefore has excellent activity against wide range of gram (-) bacteria. Cefixime binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death. A/E: Diarrhea, nausea, vomiting, abdominal pain; headache, dizziness, thrombocytopenia, eosinophilia. Potentially Fatal: Pseudomembranous colitis. Nursing Interventions: >Determine previous hypersensitivity rxns to cephalosporins, penicillins & hx of other allergies >Perform c&s tests prior to initiation of therapy and periodically during therapy. >Discontinue if seizures assoc w/ drug therapy occur >Monitor for superinfections caused by overgrowth of nonsusceptible organisms, particularly during prolonged use. >Monitor I&O rates & pattern: nephrotoxicity occurs more frequently in pts >50 y/o, w/ impaired renal fxn, in the debilitated, and in pts receiving high doses of other nephrotoxic drugs >Promptly report loose stools/ diarrhea, w/c may indicate pseudomembranous colitis. D/C of drug may be necessary Pt. and Family Education: >Report loose stools/diarrhea. Older adult are more susceptible to P. colitis >Do not miss any doses & take the doses at evenly spaced times, day & night > Do not BF while taking this drug w/o consulting physician

Generic Name: Cetirizine Brand Name: Reactine, Zyrtec Classification: Antihistamine, H-1 receptor antagonist, non-sedating Indication: for the relief of symptoms associated with seasonal allergic rhinitis due to allergens such as ragweed, grass and tree pollens in adults and children 2 years of age and older. Symptoms treated effectively include sneezing, rhinorrhea, nasal pruritus, ocular pruritus, tearing, and redness of the eyes; for the relief of symptoms associated with perennial allergic rhinitis due to allergens such as dust mites, animal dander and molds in adults and children 6 months of age and older. Symptoms treated effectively include sneezing, rhinorrhea, postnasal discharge, nasal pruritus, ocular pruritus, and tearing. Mechanism of Action: Cetirizine competes with histamine for binding at H1-receptor sites on the effector cell surface, resulting in suppression of histaminic edema, flare, and pruritus. The low incidence of sedation can be attributed to reduced penetration of cetirizine into the CNS as a result of the less lipophilic carboxyl group on the ethylamine side chain. A/E: Constipation, diarrhea, dry mouth, drowsiness, sedation, headache, depression Nursing Interventions: >Monitor for drug interactions. As the drug is higly protein bound, the potential for interactions w/ other protein bound drugs exist > Monitor for sedation especially older adults Pt. and Family Education: >Do not use in combination with OTC antihistamines >Do not engage driving/ other hazardous activities, before experiencing your responses to the drug > Do not BF while taking this drug w/o consulting physician

Generic Name: Methylprednisolone(Medrol) aceteate(Duralone) sodium succinate(A-Methapred) Classification: Hormone & synthetic substitute, adrenal corticosteroid, glucocorticiid, antiinflammatory Indication: Antiinflammatory- management of acute & chronic inflammatory dses, for palliative mgmnt of neoplastic dses, & for control of severe, acute & chronic allergic processes. High dose, short term therapy: management of acute bronchial asthma, prevention of fat embolism in pt. with long bone fracture Mechanism of Action: Unbound glucocorticoids cross cell membranes and bind with high affinity to specific cytoplasmic receptors, modifying transcription and protein synthesis. By this mechanism, glucocorticoids can inhibit leukocyte infiltration at the site of inflammation, interfere with mediators of inflammatory response, and suppress humoral immune responses. The antiinflammatory actions of corticosteroids are thought to involve phospholipase A2 inhibitory proteins, lipocortins, which control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes. A/E: Edema, hypertension, arrhythmia; CNS, endocrine, metabolic and GI effects; hirsutism, acne, skin atrophy, bruising, hyperpigmentation; transient leukocytosis; arthralgia, muscle weakness, osteoporosis, fractures, cataracts, glaucoma; infections, hypersensitivity reactions, avascular necrosis, secondary malignancy, intractable hiccups. Nursing Interventions: >Monitor periodically kidney & liver fxn, thyroid fxn, CBC, serum electrolytes, weight, and total cholesterol >Monitor DM for loss of glycemic control >Monitor serum K & report s & sx of hypokalemia > Monitor & report s & sx of Cushings syndrome Pt. and Family Education: >Consult physician for: slow wound healing, significant insomnia/confusion/unexplained bone pain >Do not alter established dosage regimen. Withdrawal sx (rebound inflammation, fever) can be induced w/ sudden discontinuation of therapy >Report onset of signs of hypocorticism adrenal insufficiency immediately: fatigue, nausea, anorexia, joint pain, muscular weakness, dizziness, fever >Do not BF while taking this drug w/o consulting physician

Generic Name: Vitamin B-complex, vitamin A, CM-Glucan, Chlorella Growth Factor (CGF), taurine and L-lysine HCl Brand Name: Cherifer Immunomax Classification: Vitamins & Minerals (Pediatric) Indication: Food supplement for growth and development of kids with the immune-boosting activity of CM-Glucan that can help in the prevention of recurrent colds, flu and respiratory tract infections, especially during rainy months. Adjuvant therapy in cold, flu, respiratory tract infections and other immune system threats, asthma and primary complex/pediatric tuberculosis. Mechanism of Action: CM-Glucan belongs to the family of -glucans. -glucan is derived from the cell walls of Saccharomyces cerevisiae, a baker's yeast. While glucan from yeast is a very potent stimulator of the immune system, it has low solubility that makes it difficult to be absorbed in the digestive tract. Cherifer Immunomax contains CM-Glucan, a glucan that has undergone carboxymethylation, a Swiss-patented process exclusive to Immunomax, producing CM-Glucan, which can be readily absorbed and used by the body. CM-Glucan has the ability to bind with the receptors of the macrophages, activating these along with neutrophils and eosinophils, and other white blood cells to stimulate the immune system, the defense mechanism of our body. CM-Glucan increases phagocytosis, the process by which white blood cells engulf and destroy invading bacteria, virus and fungi. By enhancing phagocytosis, CM-Glucan also sets off the entire immune system cascade of B- and T-lymphocytes and the complement system. Cherifer Immunomax contains the growth-promoting and cell-nourishing substance, chlorella growth factor (CGF). Chlorella growth factor's nucleic acids serve as building blocks for maximized growth potential, tissue repair and healing for the children. Cherifer Immunomax also contains taurine, which promotes the optimum brain development of a smarter, healthier child. Taurine is important for the development of better visual and motor skills in a growing child. Together with taurine, vitamin A improves vision through the proper development of retina. Cherifer Immunomax also contains vitamin B-complex, which promotes a more efficient metabolism in active, growing bodies. Sufficient amounts of B-complex vitamins provide maximized aid in the absorption and utilization of proteins, fats and carbohydrates in a child's diet. The benefits of Cherifer complement the benefits of CMGlucan: Maximum nutritional value that results in maximum growth, optimum brain development, better vision and more efficient metabolism. Nursing Interventions: >WOF hypersensitivity

Generic Name: Fluticasone Propionate Brand Name: Flonase, Dymista Classification: Topical corticosteroids used for prophylaxis and treatment of allergic rhinitis; class of potent (group III) corticosteroids. Used in the treatment of dermatological diseases Indication: management of the nasal symptoms of seasonal and perennial allergic and nonallergic rhinitis in adults and pediatric patients 4 years of age and older. Mechanism of Action: Binds to the glucocorticoid receptor. Unbound corticosteroids cross the membranes of cells such as mast cells and eosinophils, binding with high affinity to glucocorticoid receptors (GR). The results include alteration of transcription and protein synthesis, a decreased release of leukocytic acid hydrolases, reduction in fibroblast proliferation, prevention of macrophage accumulation at inflamed sites, reduction of collagen deposition, interference with leukocyte adhesion to the capillary wall, reduction of capillary membrane permeability and subsequent edema, reduction of complement components, inhibition of histamine and kinin release, and interference with the formation of scar tissue. In the management of asthma, the glucocorticoid receptor complexes down-regulates proinflammatory mediators such as interleukin-(IL)-1, 3, and 5, and up-regulates antiinflammatory mediators such as IkappaB [inhibitory molecule for nuclear factor kappaB1], IL-10, and IL-12. The antiinflammatory actions of corticosteroids are also thought to involve inhibition of cytosolic phospholipase A2 (through activation of lipocortin-1 (annexin)) which controls the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes. A/E: nasal mucous membrane irritation, in conjunction with administration of other corticosteroids, symptoms of hypercorticism, e.g., Cushing syndrome Nursing Interventions: >Assess congestion (nasal, sinus, eustachian tube) before and periodically during therapy >Monitor pulse and BP before beginning therapy & periodically during therapy >Assess lung sounds and character of bronchial secretions >Maintain fluid intake of 1500-2000 mL/day to decrease viscosity of secretions >Do not confuse Sudafed with sotalol or Sudafed PE >Administer pseudoephedrine at least 2 hr before bedtime to minimize insomnia. PO: Extended-release tablets and capsules should be swallowed whole; do not crush, break, or chew. Contents of the capsule can be mixed with jam or jelly and swallowed without chewing for patients with difficulty swallowing. Pt. and Family Education: >Take medication as directed and not to take more than recommended >Take missed doses within 1 hr; if remembered later, omit >Do not double doses >Caution parents to avoid OTC cough and cold products while breastfeeding or to children <4 yr >Instruct patient to notify health care professional if nervousness, slow or fast heart rate, breathing difficulties, hallucinations, or seizures occur, because these symptoms may indicate overdose >Instruct patient to contact health care professional if symptoms do not improve within 7 days or if fever is present

Generic Name: Ascorbic Acid Brand Name: Cecon Classification: Vitamin Indication: Prophylaxis and ttt of scurvy & as a dietary supplement Mechanism of Action: In humans, an exogenous source of ascorbic acid is required for collagen formation and tissue repair by acting as a cofactor in the posttranslational formation of 4hydroxyproline in -Xaa-Pro-Gly- sequences in collagens and other proteins. Ascorbic acid is reversibly oxidized to dehydroascorbic acid in the body. These two forms of the vitamin are believed to be important in oxidation-reduction reactions. The vitamin is involved in tyrosine metabolism, conversion of folic acid to folinic acid, carbohydrate metabolism, synthesis of lipids and proteins, iron metabolism, resistance to infections, and cellular respiration. A/E: Diarrhea, GI disturbances. May cause acidification of the urine; precipitation of urate, cystine or oxalate stones, or drugs in the urinary tract. Nursing Interventions: >Periodic hct & hgb, serum electrolytes >Monitor for s & sx of acute hemolytic anemia, sickle cell crisis Pt. and Family Education: >High doses are not recommended during pregnancy >Take large doses in divided amts because the body uses only what is needed at a particular time & excretes the rest in urine >Megadose can interfere w/ absorption of B12 >Increases the absorption of iron when taken at the same time as iron-rich foods

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