DRUG STUDY 1.

ceftazidime 1g/IV q8 Drug classes Antibiotic Cephalosporin (third generation) Therapeutic actions Bacterial: Inhibits synthesis of bacterial cell wall Causing cell death Indications Lower respiratory infections UTI Gynecologic infections Skin and skin structure infections Septicemea Intra-abdominal infections CNS infections Bone and joint infections Contraindications and cautions Contraindicated with allergy to cephalosporin or penicillin Available forms Powder for injection- 500mg, 1, 2g: injection- 1,2g Dosages Adult: 1g every IV Adverse effects CNS: Headache, dizziness, lethargy, paresthesias GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, hepatoxicity Hematologic: Bone marrow depression- decreased WBC count, decreased platelets, decreased Hct Hypersensitivity: Ranging from rash to fever to anaphylaxis, serum sickness reaction Local: Pain, abscess at injection site, phlebitis, inflammation at IV site Other: Superinfections Interactions Drug-drug: Increased nephrotoxicity with aminoglycosides, Increased bleeding effects with oral anticoagulants, Disulfiram- like reaction if combined with alcohol during or for 3 days after completion of therapy Drug-lab test: Possibility of false results on test of urine glucose using Benedicts solution. Clinitest tablets, urinary 17-ketosteroids, direct Coombs test Nursing Considerations Assessment History: Hepatic and renal impairment, lactation, pregnancy Physical: Skin status, LFTs, renal function test, culture of affected area, sensitivity tests Teaching points Avoid alcohol when taking this drug and for 3 days after because severe reactions often occur.

You may experience these side effects: Stomach upset or diarrhea. Report severe diarrhea, difficulty breathing, unsual tiredness or fatigue, pain at injection site. 2. tranexamic acid 500mg IV q6 Drug class Antifibrinolytic Indications Treatment of cyclic heavy menstrual bleeding Dosage and special alerts 1,300 mg PO tid for a maximum of 5 days during monthly menstruation. Reduce dosage with renal impairment. Increased risk of clots, stroke and MI if combined with hormonal contraceptives, antihemophilic agnents, or oral tretinoin. Visual changes or severe allergic reaction should lead to immediate discontinuation of drug. Cerebral infarct and cerebral edema have occurred. Most common adverse effects include pain, sinus and nasal symptoms, aemia and fatigue. 3. omeprazole 40mg/ IV OD Drug classes Antisecretory drug Proton pump inhibitor Therapeutic actions Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric parietal cells, blocks the final step of acid production. Indications Short-term treatment of active duodenal ulcer Treatment of heartburn or symptoms of GERD Short-term treatment of active benign gastric ulcer GERD; severe erosive esophagitis, poorly responsive symptomatic GERD Long-term therapy: Treatment of pathologic hypersecretory conditions Contraindications and cautions Contraindicated with hypersensitivity to omeprazole or its components Available forms DR capsules- 10, 20, 40 mg DR tablets- 20mg (OTC) powder for oral suspension- 20, 40 mg/packet (Zegerid) capsules- 20, 40 mg (Zegerid) Adverse Effects CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities Dermatologic: Rash, inflammation, urticaria, pruritis, alopecia, dry skin

GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy Respiratory: URI symptoms, cough, epistaxis Other: Cancer in preclinical studies, back pain, fever Interactions Drug-drug: Increased serum levels and potential increase in toxicity of benzodiazepines, phenytoin, warfarin, if these combinations are used, monitor patient closely. Decreased absorption with sucralfate; give these drugs at least 30 min. Apart Nursing considerations Teaching points Take the drug before meals. Swallow the capsules whole, do not chew, open, or crush them. Do not use any other liquid or food to dissolve the packet. This drug will need to be taken for up to 8 weeks or for a prolonged period. Have regular medical follow-up visits. You may experience these side effects: Dizziness; headache; nausea; vomiting; diarrhea; symptoms of URI; cough Report severe headache, worsening of symptoms, fever, chills, severe diarrhea 4. Ciprofloxacin 200mg/ IV q12 Drug classes Antibacterial Fluoroquinolone Therapeutic actions Bactericidal; interferes with DNA replication in susceptible bacteria preventing cell production Indications For the treatment of infections caused by susceptible gram-negative bacteria Treatment of uncomplicated UTIs Otic: Treatment of acute otitis externa Treatment of chronic bacterial prostatitis Containdications and cautions Contraindicated with allergy to ciprofloxacin, norfloxacin or other fluoroquinolones Use cautiously with renal impairment, seizures, tendinitis or tendon rupture associated with fluoroquinolone use. Available forms Tablets- 100, 250, 500, 750 mg ER tablets- 500, 1000 mg Injection- 200, 400 mg Microcapsules for suspension- 250, 500 mg Opthalmic ointment- 3.33 mg/g Opthalmic solution- 3.5 mg/ml Otic suspension- 2 mg/ml

Adverse effects CNS: Headache, dizziness, insomnia, fatigue, somnolence, depression, blurred vision, hallucinations, ataxia, nightmares CV: Arrhythmias, hypotension, angina EENT: Dry eye, eye pain, keratopathy GI: Nausea, vomiting, dry mouth, diarrhea, abdominal pain GU: Renal failure Hematologic: Elevated BUN, AST, ALT serum creatinine and alkaline phosphatise, decreased WBC count, neutrophil count, Hct Other: Fever, rash Interactions Drug-drug Decreased therapeutic effect with iron salts, sucralfate Decreased absorption with antacids, didanosine Increased serum levels and toxic effects of theophyllines if taken concurrently with ciprofloxacin Increased effects of coumarin or its derivatives Increased risk of seizures with foscarnet Drug-alternative therapy Increased risk of severe photosensitivity reactions if combined with St. Johns wort Nursing considerations Teaching points If an antacid is needed, take it at least 2 hours before or after dose. Swallow ER tablets whole; do not cut, crush or chew them. Do not touch tip of eye ointment or solution as this may contaminate the product. Drink plenty of fluids while you are taking this drug. You may experience these side effects: Nausea, vomiting, abdominal pain, diarrhea or constipation; drowsiness, blurring of vision, dizziness. Report rash, visual changes, severe GI problems, weakness, tremors. 5. hydrocortisone 100g/ IV q8 Generic Name hydrocortisone, hydrocortisone acetate , hydrocortisone butyrate ,hydrocortisone cypionate, hydrocortisone sodium succinate , hydrocortisone valerate Brand Name Dermatologic cream, ointment: Cortaid with Aloe, Cortef Cream (CAN), Cortef Feminine Itch, Corticaine, Cortoderm (CAN), Gynecort Female Creme, Lanacort-5, Lanacort-10, Maximum Strength Caldecort, Maximum Strength Cortaid Dermatologic ointment and cream: Locoid Oral suspension: Cortate (CAN), Cortef IV, IM, or subcutaneous injection: Hydrocortone phosphate IV, IM injection: Solu-Cortef Dermatologic cream, ointment, lotion: Westcort Classification

Corticosteroid (short acting), Glucocorticoid, Adrenal cortical steroid, Hormone Dosage & Route ADULTS Individualize dosage, based on severity and response. Give daily dose before 9 AM to minimize adrenal suppression. If long-term therapy is needed, alternate-day therapy should be considered. After long-term therapy, withdraw drug slowly to avoid adrenal insufficiency. For maintenance therapy, reduce initial dose in small increments at intervals until lowest clinically satisfactory dose is reached. IM, IV (hydrocortisone sodium succinate) 100500 mg initially and q 210 hr, based on condition and response. Acute adrenal insufficiency (hydrocortisone sodium phosphate): 100 mg IV followed by 100 mg q 8 hr in IV fluids. Therapeutic actions Hydrocortisone is a corticosteroid used for its anti-inflammatory and immunosuppressive effects. Its anti-inflammatory action is due to the suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability. It may also be used as replacement therapy in adrenocortical insufficiency. Indications Replacement therapy in adrenal cortical insufficiency Allergic statessevere or incapacitating allergic conditions Hypercalcemia associated with cancer Short-term inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders Hematologic disordersthrombocytopenic purpura, erythroblastopenia Trichinosis with neurologic or myocardial involvement Ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and lymphomas Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques Retention enema: For ulcerative colitis, proctitis Dermatologic preparations: To relieve inflammatory and pruritic manifestations of dermatoses that are steroid responsive Anorectal cream, suppositories: To relieve discomfort of hemorrhoids and perianal itching or irritation Adverse effects Sodium and fluid retention. Potassium and calcium depletion. Muscle wasting, weakness, osteoporosis. GI disturbances and bleeding. Increased appetite and delayed wound healing. Bruising, striae, hirsutism, acne, flushing. Raised intracranial pressure, headache, depression, psychosis, menstrual irregularities. Hyperglycaemia, glycosuria, DM, obesity, moon-face, buffalo hump. Suppression of pituitary-adrenocortical system. Growth retardation in childn (prolonged therapy). Increased susceptibility for infection. Topical use: Dermal atrophy, local irritation, folliculitis, hypertrichosis. Inhaled corticosteroids: May cause hoarseness, candidiasis of mouth and

throat. Topical application to the eye: Can produce corneal ulcers, raised IOP and reduced visual function. Intralesional injection: Local hypopigmentation of deeply pigmented skin. Intra-articular injection: Joint damage, fibrosis esp in load bearing joints. Potentially Fatal: Abrupt withdrawal leading to acute adrenal insufficiency. Rapid IV Inj may cause CV collapse. Contraindications Viral/fungal infections, tubercular or syphilitic lesions, bacterial infections unless used in conjunction with appropriate chemotherapy. Nursing considerations Assessment History: Infections; kidney disease; liver disease, hypothyroidism; ulcerative colitis with impending perforation; diverticulitis; recent GI surgery; active or latent peptic ulcer; inflammatory bowel disease; hypertension, CHF; thromboembolitic tendencies, thrombophlebitis, osteoporosis, seizure disorders, metastatic carcinoma, diabetes mellitus; lactation. Retention enemas, intrarectal foam: Systemic fungal infections; recent intestinal surgery, extensive fistulas. Topical dermatologic administration: Fungal, tubercular, herpes simplex skin infections; vaccinia, varicella; ear application when eardrum is perforated Physical: Systemic administration: Weight, T; reflexes, affect, bilateral grip strength, ophthalmologic examination; BP, P, auscultation, peripheral perfusion, discoloration, pain or prominence of superficial vessels; R, adventitious sounds, chest x-ray; upper GI x-ray (history or symptoms of peptic ulcer), liver palpation; CBC, serum electrolytes, 2-hr postprandial blood glucose, urinalysis, thyroid function tests, serum cholesterol. Topical, dermatologic preparations: Affected area, integrity of skin Interventions Systemic administration WARNING: Give daily before 9 AM to mimic normal peak diurnal corticosteroid levels and minimize HPA suppression. Space multiple doses evenly throughout the day. Do not give IM injections if patient has thrombocytopenic purpura. Rotate sites of IM repository injections to avoid local atrophy. Use minimal doses for minimal duration to minimize adverse effects. Taper doses when discontinuing high-dose or long-term therapy. Arrange for increased dosage when patient is subject to unusual stress. Ensure that adequate amount of Ca2+ is taken if prolonged administration of steroids. Use alternate-day maintenance therapy with short-acting corticosteroids whenever possible. WARNING: Do not give live virus vaccines with immunosuppressive doses of hydrocortisone. Provide antacids between meals to help avoid peptic ulcer. Topical dermatologic administration Systemic administration Take this drug exactly as prescribed. Do not stop taking this drug without notifying your health care provider; slowly taper dosage to avoid problems.

Dosage reductions may create adrenal insufficiency. Report any fatigue, muscle and joint pains, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness, or low blood sugar (if you monitor blood sugar). Take with meals or snacks if GI upset occurs. Take single daily or alternate-day doses before 9 AM; mark calendar or use other measures as reminder of treatment days. Do not overuse joint after intra-articular injections, even if pain is gone. Frequent follow-up visits to your health care provider are needed to monitor drug response and adjust dosage. Wear a medical alert ID (if you ae using long-term therapy) so that any emergency medical personnel will know that you are taking this drug. You may experience these side effects: Increase in appetite, weight gain (some of gain may be fluid retention; monitor intake); heartburn, indigestion (eat frequent small meals; use of antacids may help); increased susceptibility to infection (avoid crowds during peak cold or flu seasons, and avoid anyone with a known infection); poor wound healing (if injured or wounded, consult health care provider); muscle weakness, fatigue (frequent rest periods may help). Report unusual weight gain, swelling of lower extremities, muscle weakness, black or tarry stools, vomiting of blood, epigastric burning, puffing of face, menstrual irregularities, fever, prolonged sore throat, cold or other infection, worsening of symptoms. Intra-articular, intralesional administration Do not overuse the injected joint even if the pain is gone. Adhere to rules of proper rest and exercise. Topical dermatologic administration Apply sparingly, and rub in lightly Avoid contacting your eye with the medication. Report burning, irritation, or infection of the site, worsening of the condition. Avoid prolonged use. Anorectal preparations Maintain normal bowel function with proper diet, adequate fluid intake, and regular exercise. Use stool softeners or bulk laxatives if needed. Notify your health care provider if symptoms do not improve in 7 days or if bleeding, protrusion, or seepage occurs. 6. Kalium Durules 2 durules BID Generic Name Kalium durule Brand Name Potassium Chloride Classifications electrolytic and water balance agent; replacement solution Adverse Effects GI: Nausea, vomiting, diarrhea, abdominal distension.

Body Whole: Pain, mental confusion, irritability, listlessness, paresthesias of extremities, muscle weaknessand heaviness of limbs, difficulty in swallowing, flaccid paralysis. Urogenital: Oliguria, anuria. Hematologic: Hyperkalemia. Respiratory: Respiratory distress. CV: Hypotension, bradycardia; cardiac depression, arrhythmias, or arrest; altered sensitivity to digitalis glycosides. ECG changes in hyperkalemia: Tenting (peaking) of T wave (especially in right precordial leads), lowering of R with deepening of S waves and depression of RST; prolonged P-R interval, widened QRS complex, decreased amplitude and disappearance of P waves, prolonged Q-T interval, signs of right and left bundle block, deterioration of QRS contour and finally ventricular fibrillation and death. Indication To prevent and treat potassium deficit secondary to diuretic or corticosteroid therapy. Also indicated when potassium is depleted by severe vomiting, diarrhea; intestinal drainage, fistulas, or malabsorption; prolonged diuresis, diabetic acidosis. Effective in the treatment of hypokalemic alkalosis (chloride, not the gluconate). Contraindication Severe renal impairment; severe hemolytic reactions; untreated Addisons disease; crush syndrome; early postoperative oliguria (except during GI drainage); adynamic ileus; acute dehydration; heat cramps, hyperkalemia, patients receiving potassium-sparing diuretics, digitalis intoxication with AV conduction disturbance. Nursing Responsibilities Monitor I&O ratio and pattern in patients receiving the parenteral drug. If oliguria occurs, stop infusion promptly and notify physician. Monitor for and report signs of GI ulceration (esophageal or epigastric pain or hematemesis). Monitor patients receiving parenteral potassium closely with cardiac monitor. Irregular heartbeat is usually the earliest clinical indication of hyperkalemia. Be alert for potassium intoxication (hyperkalemia, see S&S, Appendix F); may result from any therapeutic dosage, and the patient may be asymptomatic. The risk of hyperkalemia with potassium supplement increases (1) in older adults because of decremental changes in kidney function associated with aging, (2) when dietary intake of potassium suddenly increases, and (3) when kidney function is significantly compromised.