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Generic Name: Amikacin sulfate Brand Name: Amikin Classifications: Anti-infective; Aminoglycoside Availability 250 mg/mL, 50 mg/mL injection

Actions Semisynthetic derivative of kanamycin with broad range of antimicrobial activity that includes many strains resistant to other aminoglycosides. Pharmacologic properties are essentially the same as those of gentamicin. Appears to inhibit protein synthesis in bacterial cell and is usually bactericidal.

Therapeutic Effects Effective against a wide variety of gram-negative bacteria including Escherichia coli, Enterobacter, Klebsiella pneumoniae, most strains of Pseudomonas aeruginosa, and many strains of Proteus species, Serratia, Providencia stuartii, Citrobacter freundii, Acinetobacter. Also effective against penicillinase- and non-penicillinase-producing Staphylococcus species, and against Mycobacterium tuberculosis and atypical mycobacteria.

Uses Primarily for short-term treatment of serious infections of respiratory tract, bones, joints, skin, and soft tissue, CNS (including meningitis), peritonitis burns, recurrent urinary tract infections (UTIs).

Contraindications History of hypersensitivity or toxic reaction with an aminoglycoside antibiotic.

Route & Dosage Moderate to Severe Infections Child: IV/IM 57.5 mg/kg loading dose, then 5 mg/kg q8h or 7.5 mg/kg q12h

Administration

Intravenous Verify correct IV concentration and rate of infusion with physician for neonates, infants, and children. Adverse Effects ( 1%) CNS: Neurotoxicity: drowsiness, unsteady gait, weakness, Vestibular: dizziness, ataxia. GI: Nausea, vomiting, hepatotoxicity.

Interactions Drug: ANESTHETICS, SKELETAL MUSCLE RELAXANTS have additive neuromuscular blocking effects; acyclovir, amphotericin B, bacitracin, capreomycin, cephalosporins, colistin, cisplatin, carboplatin, methoxyflurane, polymyxin B, vancomycin, furosemide, ethacrynic acid increase risk of ototoxicity and nephrotoxicity.

Nursing Considerations Assessment & Drug Effects Baseline tests: Before initial dose, C&S; renal function and vestibulocochlear nerve function (and at regular intervals during therapy; closely monitor in the older adult, patients with documented ear problems, renal impairment, or during high dose or prolonged therapy). Lab tests: Periodic serum creatinine and BUN, complete urinalysis. With treatment over 10 d, daily tests of renal function, weekly audiograms, and vestibular tests are strongly advised. Monitor & report any changes in I&O, oliguria, hematuria, or cloudy urine. Keeping patient well hydrated reduces risk of nephrotoxicity; consult physician regarding optimum fluid intake.

Patient & Family Education Report immediately any changes in hearing or unexplained ringing/roaring noises or dizziness, and problems with balance or coordination.

Generic Name: Albuterol Brand Name: Salbutamol, Proventil, Ventolin, Accuneb, airet, Novo-Salbutamol, Proventil HFA, Gen-salbutamol, Ventodisk, Ventolin HFA, Volmax, VoSpira ER Classification: Bronchodilator (therapeutic); adrenergics (pharmacologic) Indications To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (COPD) Quick relief for bronchospasm For the prevention of exercise-induced bronchospasm Long-term control agent for patients with chronic or persistent bronchospasm

Mechanism of Action It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles. The relief from nasal congestion and bronchospasm is made possible by the following mechanism that takes place when Salbutamol is administered. First, it binds to the beta2-adrenergic receptors in the airway of the smooth muscle which then leads to the activation of the adenyl cyclase and increased levels of cyclic35-adenosine monophosphate (cAMP).

Contraindications Hypersensitivity to adrenergic amines Hypersensitivity to fluorocarbons

Precaution Excess inhaler use which may lead to tolerance and paradoxical bronchospasm

Side Effects and Adverse Reactions Nervousness Restlessness Tremor Headache Insomnia Chest pain Palpitations Route and Dosage Angina Arrhythmias Hypertension Nausea and vomiting Hyperglycemia Hypokalemia

PO (Adults and Children more than 12 years): 2-4 mg 3-4 times a day or 4-8 mg of extended dose tablets twice a day. Nursing Interventions Assess lung sounds, PR and BP before drug administration and during peak of medication. Observe fore paradoxical spasm and withhold medication and notify physician if condition occurs. Administer PO medications with meals to minimize gastric irritation. Extended-release tablet should be swallowed-whole. It should not be crushed or chewed. If administering medication through inhalation, allow at least 1 minute between inhalation of aerosol medication. Advise the patient to rinse mouth with water after each inhalation to minimize dry mouth. Inform the patient that Albuterol may cause an unusual or bad taste.

Generic Name: Paracetamol, Acetaminophen Brand Name: Biogesic, Panadol, Tylenol Classification: Non-narcotic analgesic, Antipyretic Uses: Control of pain due to headache, earache, dysmenorrhea, arthralgia, myalgia, musculoskeletal pain, arthritis, immunizations, teething, tonsillectomy To reduce fever in viral and bacterial infections As a substitute for aspirin in upper GI disease, bleeding disorders clients in anticoagulant therapy and gouty arthritis

Actions: Decreases fever by a hypothalamic effect leading to sweating and vasodilation Inhibits pyrogen effect on the hypothalamic-heat-regulating centers Inhibits CNS prostaglandin synthesis with minimal effects on peripheral prostaglandin synthesis Does not cause ulceration of the GI tract and causes no anticoagulant action.

Contraindications:

Renal Insufficiency Anemia

Side-Effects: Minimal GI upset. Methemoglobinemia Hemolytic Anemia Neutropenia Thrombocytopenia Pancytopenia Leukopenia Urticaria CNS stimulation Jaundice Glissitis Drowsiness Liver Damage

Dosage: Per Orem: 325-650mg q4h up to a maximum of 1 gram q6h. Nursing Considerations: Do not exceed 4gm/24hr. in adults and 75mg/kg/day in children. Extended-Release tablets are not to be chewed. Monitor CBC, liver and renal functions. Assess for fecal occult blood and nephritis. Avoid using OTC drugs with Acetaminophen. Take with food or milk to minimize GI upset. Report N&V. cyanosis, shortness of breath and abdominal pain as these are signs of toxicity. Report paleness, weakness and heart beat skips Report abdominal pain, jaundice, dark urine, itchiness or clay-colored stools. Phenmacetin may cause urine to become dark brown or wine-colored. Report pain that persists for more than 3-5 days Avoid alcohol. This drug is not for regular use with any form of liver disease

Generic Name : potassium salts , potassium acetate , potassium chloride ,potassium gluconate Brand Name: Injection:

Potassium Chloride , Kaon, K-G Elixir, Kolyum, Tri-K,

Twin-K

Classification:

Electrolyte formulations.

Therapeutic actions Principal intracellular cation of most body tissues, participates in a number of physiologic processesmaintaining intracellular tonicity, transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscle, maintenance of normal renal function; also plays a role in carbohydrate metabolism and various enzymatic reactions.

Indications Prevention and correction of potassium deficiency; when associated with alkalosis, use potassium chloride; when associated with acidosis, use potassium acetate, bicarbonate, citrate, or gluconate IV: Treatment of cardiac arrhythmias due to cardiac glycosides

Adverse effects GI: Nausea, vomiting, diarrhea, abdominal discomfort, GI obstruction, GI bleeding, GI ulceration or perforation Hematologic: Hyperkalemiaincreased serum K+, ECG changes (peaking of T waves, loss of P waves, depression of ST segment, prolongation of QTc interval)

Contraindications Contraindicated with allergy to tartrazine, aspirin (tartrazine is found in some preparations marketed as Kaon-Cl, Klor-Con); severe renal impairment with oliguria, anuria, azotemia; untreated Addisons disease; hyperkalemia; adynamia episodica hereditaria; acute dehydration; heat cramps; GI disorders that delay passage in the GI tract. Use cautiously with cardiac disorders, especially if treated with digitalis, pregnancy, lactation.

Nursing considerations Assessment History: Allergy to tartrazine, aspirin; severe renal impairment; untreated Addisons disease; hyperkalemia; adynamia episodica hereditaria; acute dehydration; heat cramps, GI disorders that cause delay in passage in the GI tract, cardiac disorders, lactation Physical: Skin color, lesions, turgor; injection sites; P, baseline ECG; bowel sounds, abdominal examination; urinary output; serum electrolytes, serum bicarbonate

Interventions

Arrange for serial serum potassium levels before and during therapy. Administer liquid form to any patient with delayed GI emptying. Administer oral drug after meals or with food and a full glass of water to decrease GI upset. Caution patient not to chew or crush tablets; have patient swallow tablet whole. Mix or dissolve oral liquids, soluble powders, and effervescent tablets completely in 3 8 oz of cold water, juice, or other suitable beverage, and have patient drink it slowly. Arrange for further dilution or dose reduction if GI effects are severe. Agitate prepared IV solution to prevent layering of potassium; do not add potassium to an IV bottle in the hanging position. Monitor IV injection sites regularly for necrosis, tissue sloughing, phlebitis. Monitor cardiac rhythm carefully during IV administration. Caution patient that expended wax matrix capsules will be found in the stool. Caution patient not to use salt substitutes.

Teaching points

Take drug after meals or with food and a full glass of water to decrease GI upset. Do not chew or crush tablets, swallow tablets whole. Mix or dissolve oral liquids, soluble

powders, and effervescent tablets completely in 38 ounces of cold water, juice, or other suitable beverage, and drink it slowly. Take the drug as prescribed; do not take more than prescribed.

Do not use salt substitutes. You may find wax matrix capsules in the stool. The wax matrix is not absorbed in the GI tract. Have periodic blood tests and medical evaluation. You may experience these side effects: Nausea, vomiting, diarrhea (taking the drugs with meals, diluting them further may help). Report tingling of the hands or feet, unusual tiredness or weakness, feeling of heaviness in the legs, severe nausea, vomiting, abdominal pain, black or tarry stools, pain at IV injection site

Generic Name: Omeprazole(o-mepra-zole) Brand Name: Losec,Prilosec Classifications: gastrointestinal agent; proton pump inhibitor Availability: 10 mg, 20 mg, 40 mg capsules Actions An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid secretion by inhibiting the H+, K+-ATPase enzyme system [the acid (proton H+) pump] in the parietal cells.

Therapeutic effects Suppresses gastric acid secretion relieving gastrointestinal distress and promoting ulcer healing.

Uses Duodenal and gastric ulcer. Gastroesophageal reflux disease including severe erosive esophagitis (4 to 8 wk treatment). Long-term treatment of pathologic hypersecretory conditions such as Zollinger-Ellison syndrome, multiple endocrine adenomas, and systemic mastocytosis. In combination with clarithromycin to treat duodenal ulcers associated with Helicobacter pylori.

Contraindications Long-term use for gastroesophageal reflux disease, duodenal ulcers; lactation.

Administration Oral Give before food, preferably breakfast; capsules must be swallowed whole (do not open, chew, or crush).

Note: Antacids may be administered with omeprazole. Adverse effects CNS:Headache, dizziness, fatigue.

GI:Diarrhea, abdominal pain, nausea, mild transient increases in liver function tests. Urogenital:Hematuria, proteinuria.

Nursing implications Assessment & Drug Effects Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests with prolonged use.

Patient & Family Education Report any changes in urinary elimination such as pain or discomfort associated with urination, or blood in urine. Report severe diarrhea; drug may need to be discontinued.

Generic name: Azithromycin Brand Name: Zithromax Drug class: Macrolide antibiotic Therapeutic actions Bacteriostatic or bactericidal in susceptible bacteria.

Indications Treatment of lower respiratory tract infections: acute bacterial exacerbations of COPD due to H. influenzae, Moraxella catarrhalis, S. pneumoniae; community-acquired pneumonia due to S. pneumoniae, H. influenzae

Contraindications Contraindicated with hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic.

Adverse effects Dizziness, headache, vertigo, somnolence, fatigue, Diarrhea, abdominal pain, nausea, dyspepsia, flatulence, vomiting, melena, pseudomembranous colitis, Superinfections, angioedema, rash, photosensitivity, vaginitis

Drug Interactions Decreased serum levels and effectiveness of azithromycin with aluminum and magnesium-containing antacids Possible increased effects of theophylline

Possible increased anticoagulant effects of warfarin

Interaction with Food: Food greatly decreases the absorption of azithromycin

Nursing considerations Culture site of infection before therapy. Administer on an empty stomach--1 hr before or 23 hr after meals. Food affects the absorption of this drug. Counsel patients being treated for STDs about appropriate precautions and additional therapy.

OXACILLIN Classification Penicillins Action A penicillinase resistant penicillin that inhibits cell-wall synthesis during microorganism multiplication; bacteria resists penicillins by producing penicilllinase enzymes that convert penicillins to inactivate penecillic acids. Oxacillin resists these enzymes.

Indications Systemic infections caused by penicillinase-producing staphylococci

Adverse reactions Common: Thrombophebitis Uncommon: Neuropathy, neuromuscular irritability, lethargy, hallucination, anxiety, confusion, agitation, depression, dizziness, fatigue, oral lesions, nausea, vomiting, diarrhea, enterocolitis, interstitial nephritis, nephropathy, thrombocytopenia, hemolytic anemia, anemia, hypersensitivity reactions

Nursing considerations Use cautiously in patients with other drug allergy, especially to cephalosporins. Obtain specimen for culture and sensitivity tests before first dose. To prevent vein irritation, avoid continuous infusions. Change site every 48 hours. Give 1-2 hours before or 2-3 hours after meals to prevent gastric irritation.

Generic Name :furosemide Brand Name:Apo-Furosemide (CAN),Furosemide Special (CAN),Lasix Dosage & Route of Furosemide Available forms :Tablets20, 40, 80 mg; oral solution10 mg/mL, 40 mg/5 mL; injection10 mg/mL

Pediatric Patients Avoid use in premature infants: stimulates prostaglandin E2 synthesis and may increase incidence of patent ductus arteriosus and complicate respiratory distress syndrome.

Pulmonary edema: 1 mg/kg IV or IM. May increase by 1 mg/kg in 2 hr until the desired effect is seen. Do not exceed 6 mg/kg.

Patients with Renal Impairment Up to 4 g/day has been tolerated. IV bolus injection should not exceed 1 g/day given over 30 min.

Therapeutic actions of Furosemide

Furosemide inhibits reabsorption of Na and chloride mainly in the medullary portion of the ascending. Excretion of potassium and ammonia is also increased while uric acid excretion is reduced. It increases plasma-renin levels and secondary hyperaldosteronism may result. Furosemide reduces BP in hypertensives as well as in normotensives. It also reduces pulmonary oedema before diuresis has set in.

Indications of Furosemide Oral, IV: Edema associated with CHF, cirrhosis, renal disease IV: Acute pulmonary edema Oral: Hypertension

Adverse Effects Fluid and electrolyte imbalance. Rashes, photosensitivity, nausea, diarrhoea, blurred vision, dizziness, headache, hypotension. Bone marrow depression (rare), hepatic dysfunction. Hyperglycaemia, glycosuria, ototoxicity. Potentially Fatal: Rarely, sudden death and cardiac arrest. Hypokalaemia and magnesium depletion can cause cardiac arrhythmias.

Contraindications Severe sodium and water depletion, hypersensitivity to sulphonamides and furosemide, hypokalaemia, hypernatremia, precomatose states associated with liver cirrhosis, anuria or renal failure. Addisons disease.

Nursing considerations Assessment History: Allergy to furosemide, sulfonamides, tartrazine; electrolyte depletion anuria, severe renal failure; hepatic coma; SLE; gout; diabetes mellitus; lactation, pregnancy Physical: Skin color, lesions, edema; orientation, reflexes, hearing; pulses, baseline ECG, BP, orthostatic BP, perfusion; R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns; CBC, serum electrolytes (including calcium), blood sugar, LFTs, renal function tests, uric acid, urinalysis, weight Interventions Administer with food or milk to prevent GI upset.

Give early in the day so that increased urination will not disturb sleep. Avoid IV use if oral use is at all possible. WARNING: Do not mix parenteral solution with highly acidic solutions with pH below 3.5. Do not expose to light, may discolour tablets or solution; do not use discoloured drug or solutions. Discard diluted solution after 24 hr. Refrigerate oral solution. Measure and record weight to monitor fluid changes. Arrange to monitor serum electrolytes, hydration, liver and renal function. Arrange for potassium-rich diet or supplemental potassium as needed.

Teaching points Record intermittent therapy on a calendar or dated envelopes. When possible, take the drug early so increased urination will not disturb sleep. Take with food or meals to prevent GI upset. You may experience these side effects: Increased volume and frequency of urination; dizziness, feeling faint on arising, drowsiness (avoid rapid position changes; hazardous activities, like driving; and consumption of alcohol); sensitivity to sunlight (use sunglasses, wear protective clothing, or use a sunscreen); increased thirst (suck on sugarless lozenges; use frequent mouth care); loss of body potassium (a potassium-rich diet or potassium supplement will be needed). Report loss or gain of more than 3 pounds in 1 day, swelling in your ankles or fingers, unusual bleeding or bruising, dizziness, trembling, numbness, fatigue, muscle weakness or cramps

Generic Name:Cetriaxone Brand Name:Rocephin Classifications:antiinfective; antibiotic; third-generation cephalosporin Availability 250 mg, 500 mg, 1 g, 2 g injection

Actions

Semisynthetic thirdgeneration cephalosporin antibiotic. Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing the bacterium.

Therapeutic effects Spectrum of activity similar to that of cefotaxime including most Enterobacteriaceae, most gram-positive aerobic cocci, Neisseria meningitidis, and most strains of penicillinase-producing and nonpenicillinase-producing Neisseria gonorrhoeae. Has some activity against Treponema pallidum but none against most strains of Clostridia. Effectively treats bone and joint infections, gonorrhea and intra-abdominal infections, meningitis and lower respiratory tract infections, otitis media, pelvic inflammatory disease, Proteus infections, septicemia, skin and soft tissue infections, urinary tract infections, and is used for surgical prophylaxis, reducing or eliminating infection.

Uses Infections caused by susceptible organisms in lower respiratory tract, skin and skin structures, urinary tract, bones and joints; also intra-abdominal infections, pelvic inflammatory disease, uncomplicated gonorrhea, meningitis, and surgical prophylaxis.

Contraindicatons Hypersensitivity to cephalosporins and related antibiotics;

Route & Dosage

child:IV/IM 5075 mg/kg/d in 2 divided doses (max 2 g/d)

Adverse Effects BodyWhole:Pruritus, fever, chills, pain, induration at IM injection site; phlebitis (IV site).

GI: Diarrhea, abdominal cramps, pseudomembranous colitis, biliary sludge. Urogenital:Genital pruritus; moniliasis.

Nursing implications Assessment & Drug Effects

Determine history of hypersensitivity reactions to cephalosporins and penicillins and history of other allergies, particularly to drugs, before therapy is initiated. Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy. Dosage may be started pending test results. Periodic coagulation studies (PT and INR) should be done. Inspect injection sites for induration and inflammation. Rotate sites. Note IV injection sites for signs of phlebitis (redness, swelling, pain). Monitor for manifestations of hypersensitivity . Report their appearance promptly and discontinue drug. Watch and report signs: petechiae, ecchymotic areas, epistaxis, or any unexplained bleeding. Ceftriaxone appears to alter vitamin K-producing gut bacteria; therefore, hypoprothrombinemic bleeding may occur.

Patient & Family Education Report any signs of bleeding. Report loose stools or diarrhea promptly.