Omeprazole LoSec (CAN), Prilosec Drug Classes Antisecretory agent; Proton pump inhibitor Therapeutic actions Gastric acid-pump

p 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; First-line therapy in treatment of heartburn or symptoms of gastroesophageal reflux disease (GERD); Short-term treatment of active benign gastric ulcer; GERD, severe erosive esophagitis, poorly responsive symptomatic GERD; Treatment of pathologic hypersecretory conditions ( Zollinger-Ellison syndrome, multiple adenomas, systemic mastocytosis) (long-term therapy); Eradication of H. pylori with amoxicillin; Unlabeled use: posterior laryngitis; enhance efficacy of pancreatin for the treatment of steatorrhea in cystic fibrosis Contraindications/cautions Contraindications: hypersensitivity to omeprazole or its components. Use cautiously with pregnancy, lactation. Dosage Available Forms: DR capsules--10, 20, 40 mg Adult : Active duodenal ulcer:20 mg PO qd for 4---8 wk. Should not

be used for maintenance therapy. ; Active gastric ulcer: 40 mg PO qd for 4---8 wk. ; Severe erosive esophagitis or poorly responsive GERD: 20 mg PO daily for 4---8 wk. Do not use as maintenance therapy. Do not use >8 wk. Pathologic hypersecretory conditions: Individualize dosage. Initial dose is 60 mg PO qd. Doses up to 120 mg tid have been used. Administer daily doses of > 80 mg in divided doses. Adverse Effects CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities; GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy; Respiratory: URI symptoms, cough, epistaxis; Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin; Other: Cancer in preclinical studies, back pain, fever Clinically important drug-drug interactions Increased serum levels and potential increase in toxicity of benzodiazepines Nursing Considerations Assessment History: Hypersensitivity to omeprazole or any of its components, pregnancy, lactation Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal exam; respiratory auscultation Implementation Administer before meals. Caution patient to swallow capsules whole, not to open, chew, or crush. Arrange for further evaluation of patient after 8 wk of therapy for gastroreflux disorders; not intended for maintenance therapy. Symptomatic improvement does not rule out gastric cancer, which did occur in preclinical studies. Administer antacids with omeprazole, if needed.

Dexamethasone Drug Classes Corticosteroid; Glucocorticoid; Hormone Therapeutic actions Enters target cells and binds to specific receptors, initiating many complex reactions that are responsible for its antiinflammatory and immunosuppressive effects. Indications Hypercalcemia associated with cancer; Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders; Hematologic disorders: thrombocytopenic purpura, erythroblastopenia; Trichinosis with neurologic or myocardial involvement; Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some leukemias and lymphomas Contraindications/cautions Contraindications: infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and varicella, and antibioticresistant infections. Use cautiously with renal or hepatic disease; hypothyroidism, ulcerative colitis with impending perforation; diverticulitis; active or latent peptic ulcer; inflammatory bowel disease; CHF, hypertension, thromboembolic disorders; osteoporosis; convulsive disorders; diabetes mellitus; lactation. Dosage Available Forms: Tablets--0.25, 0.5, 0.75, 1, 1.5, 2, 4, 6 mg; elixir--0.5 mg/5ml; oral solution--0.5 mg/5ml;

injection--8 mg/ml, 16 mg/ml, 4 mg/ml, 10 mg/ml, 20 mg/ml, 24 mg/ml; aerosol--84 g/actuation; ophthalmic solution--0.1%; ophthalmic suspension--0.1%; ophthalmic ointment--0.05%; Adverse Effects CNS: Convulsions, vertigo, headaches, pseudotumor cerebri, euphoria, insomnia, mood swings, depression, psychosis, intracerebral hemorrhage, reversible cerebral atrophy in infants, cataracts, increased intraocular pressure, glaucoma ; GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention ; CV: Hypertension, CHF, necrotizing angiitis ; Hematologic: Fluid and electrolyte disturbances, negative nitrogen balance, increased blood sugar, glycosuria, increased serum cholesterol, decreased serum T3 and T4 levels ; GU: Amenorrhea, irregular menses ; MS: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fractures ; Endocrine: Growth retardation, decreased carbohydrate tolerance, diabetes mellitus, cushingoid state, secondary adrenocortical and pituitary unresponsiveness; Hypersensitivity: Anaphylactoid or hypersensitivity reactions; Other: Impaired wound healing; petechiae; ecchymoses; increased sweating; thin and fragile skin; acne; immunosuppression and masking of signs of infection; activation of latent infections, including tuberculosis, fungal, and viral eye infections; pneumonia; abscess; septic infection; GI and GU infections Clinically important drug-drug interactions Increased therapeutic and toxic effects of cortisone with troleandomycin Decreased effects of anticholinesterases with corticotropin; profound muscular depression is possible Decreased steroid blood levels with phenytoin, phenobarbital, rifampin Decreased serum levels of salicylates with cortisone.

Nursing Considerations For systemic administration: Do not give drug to nursing mothers; drug is secreted in breast milk. Give daily doses before 9 am to mimic normal peak corticosteroid blood levels. Increase dosage when patient is subject to stress. Taper doses when discontinuing high-dose or long-term therapy. Do not give live virus vaccines with immunosuppressive doses of corticosteroids. For respiratory inhalant, intranasal preparation: Do not use respiratory inhalant during an acute asthmatic attack or to manage status asthmaticus. Do not use intranasal product with untreated local nasal infections, epistaxis, nasal trauma, septal ulcers, or recent nasal surgery. Taper systemic steroids carefully during transfer to inhalational steroids; adrenal insufficiency deaths have occurred. For topical dermatologic preparations: Use caution when occlusive dressings, tight diapers; cover affected area; these can increase systemic absorption. Avoid prolonged use near the eyes, in genital and rectal areas, and in skin creases.

Furosemide Apo-Furosemide (CAN), Furoside (CAN), Lasix, Myrosemide (CAN) Drug Classes Loop diuretic Therapeutic actions Inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle, leading to a sodium-rich diuresis. Indications Edema associated with CHF, cirrhosis, renal disease (oral, IV); Acute pulmonary edema (IV); Hypertension (oral) Contraindications/cautions Contraindications: allergy to furosemide, sulfonamides; allergy to tartrazine (in oral solution); electrolyte depletion; anuria, severe renal failure; hepatic coma; pregnancy; lactation.; Use cautiously with SLE, gout, diabetes mellitus. Dosage Available Forms: Tablets--20, 40, 80 mg; oral solution--10 mg/ml, 40 mg/5 ml; injection--10 mg/ml IV Facts Preparation: Store at room temperature; exposure to light may slightly discolor solution. Infusion: Inject directly or into tubing of actively running IV; inject slowly over 1---2 min.

Incompatibilites: Do not mix with acidic solutions. Isotonic saline, Lactated Ringer's Injection, and 5% Dextrose Injection may be used after pH has been adjusted (if necessary); precipitates form with gentamicin, netilimicin, milrinone in 5% Dextrose, 0.9% Sodium Chloride. Adverse Effects CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss; GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation; diarrhea, acute pancreatitis, jaundice ; CV: Orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis ; Hematologic: Leukopenia, anemia, thrombocytopenia, fluid and electrolyte imbalances; GU: Polyuria, nocturia, glycosuria, urinary bladder spasm ; Dermatologic: Photosensitivity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme ;Other: Muscle cramps and muscle spasms Clinically important drug-drug interactions Increased risk of cardiac arrhythmias with digitalis glycosides (due to electrolyte imbalance) Increased risk of ototoxicity with aminoglycoside antibiotics, cisplatin Decreased absorption of furosemide with phenytoin Decreased natriuretic and antihypertensive effects with indomethacin, ibuprofen, other NSAIDs Decreased GI absorption with charcoal Nursing Considerations Assessment History: Allergy to furosemide, sulfonamides, tartrazine; electrolyte depletion anuria, severe renal failure; hepatic coma; SLE; gout; diabetes mellitus; lactation

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, liver and renal function tests, uric acid, urinalysis Implementation Administer with food or milk to prevent GI upset. Reduce dosage if given with other antihypertensives; readjust dosages gradually as BP responds. Give early in the day so that increased urination will not disturb sleep. Avoid IV use if oral use is at all possible. Do not mix parenteral solution with highly acidic solutions with pH below 3.5. Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions. Discard diluted solution after 24 h. Refrigerate oral solution. Measure and record weight to monitor fluid changes. Arrange to monitor serum electrolytes, hydration, liver function. Arrange for potassium-rich diet or supplemental potassium as needed.

Metronidazole Apo-Metronidazole (CAN), Flagyl, MetroCream (CAN), MetroGel, Metro I.V., Neo-Tric (CAN) Drug Classes Antibiotic ; Antibacterial; Amebicide; Antiprotozoal Therapeutic actions Bactericidal: inhibits DNA synthesis in specific (obligate) anaerobes, causing cell death; antiprotozoaltrichomonacidal, amebicidal: biochemical mechanism of action is not known. Indications Acute infection with susceptible anaerobic bacteria; Acute intestinal amebiasis; Amebic liver abscess; Trichomoniasis (acute and partners of patients with acute infection); Preoperative, intraoperative, postoperative prophylaxis for patients undergoing colorectal surgery; Topical application in the treatment of inflammatory papules, pustules, and erythema of rosacea; Unlabeled uses: prophylaxis for patients undergoing gynecologic, abdominal surgery; hepatic encephalopathy; Crohn's disease; antibiotic-associated pseudomembranous colitis; treatment of Gardnerella vaginalis, giardiasis (use recommended by the CDC) Contraindications/cautions Contraindications: hypersensitivity to metronidazole; pregnancy (do not use for trichomoniasis in first trimester). Use cautiously with CNS diseases, hepatic disease, candidiasis (moniliasis), blood dyscrasias, lactation. Dosage Available Forms: Tablets--250, 500 mg; powder for injection--500 mg; injection--500 mg/100 ml

IV Facts Preparation: Reconstitute by adding 4.4 ml of Sterile Water for Injection, Bacteriostatic Water for Injection, 0.9% Sodium Chloride Injection, Bacteriostatic 0.9% Sodium Chloride Injection to the vial and mix thoroughly. Adverse Effects CNS: Headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizures, peripheral neuropathy, fatigue; GI: Unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset, cramps; GU: Dysuria, incontinence, darkening of the urine; Local: Thrombophlebitis (IV); redness, burning, dryness, and skin irritation (topical); Other: Severe disulfiramlike interaction with alcohol, candidiasis (superinfection) Clinically important drug-drug interactions Decreased effectiveness with barbiturates Disulfiram-like reaction (flushing, tachycardia, nausea, vomiting) with alcohol Psychosis if taken with disulfiram Increased bleeding tendencies with oral anticoagulants Nursing Considerations Avoid use unless necessary. Metronidazole is carcinogenic in some rodents. Administer oral doses with food. Apply topically (MetroGel, MetroCream) after cleansing the area. Advise patient that cosmetics may be used over the area after application. Reduce dosage in hepatic disease.

Piperacillin sodium Pipracil Drug Classes Antibiotic; Penicillin with extended spectrum Therapeutic actions Bactericidal: inhibits synthesis of cell wall of sensitive organisms, causing cell death. Indications Treatment of mixed infections and presumptive therapy prior to identification of organisms Lower respiratory tract infections caused by Haemophilus influenzae, Klebsiella, Pseudomonas aeruginosa, Serratia, E. coli, Bacteroides, Enterobacter Intra-abdominal infections caused by E. coli, P. aeruginosa, Clostridium, Bacteroides species, including Bacteroides fragilis UTIs caused by E. coli, Proteus species, including Proteus mirabilis, Klebsiella, P. aeruginosa, enterococci Gynecologic infections caused by Neisseria gonorrhoeae, Bacteroides, enterococci, anaerobic cocci Skin and skin-structure infections caused by E. coli, P. mirabilis, indole-positive Proteus, P. aeruginosa, Klebsiella, Enterobacter, Bacteroides, Serratia, Acinetobacter Bone and joint infections caused by P. aeruginosa, Bacteroides, enterococci, anaerobic cocci Septicemia caused by E. coli, Klebsiella, Enterobacter, Serratia, P. mirabilis, Streptococcus pneumoniae, P. aeruginosa, Bacteroides, enterococci, anaerobic cocci Infections caused by Streptococcus (narrower spectrum antibiotic usually used) Prophylaxis in abdominal surgery

Contraindications/cautions Contraindications: allergies to penicillins, cephalosporins, procaine, or other allergens. Use cautiously with pregnancy, lactation (may cause diarrhea or candidiasis in the infant). Dosage Available Forms: Powder for injection--2, 3, 4 g Adverse Effects CNS: Lethargy, hallucinations, seizures; GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black hairy tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis; Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time; GU: Nephritis; Hypersensitivity reactions: Rash, fever, wheezing, anaphylaxis; Other: Superinfections, sodium overload--CHF;Local: Pain, phlebitis, thrombosis at injection site Nursing Considerations Culture infection before beginning treatment; reculture if response is not as expected. Continue therapy for at least 2 d after signs of infection have disappeared, usually 7---10 d. Administer by IM or IV routes only. Carefully check IV site for signs of thrombosis or drug reaction. Do not give IM injections repeatedly in the same site, atrophy can occur; monitor injection sites. Maintain epinephrine, IV fluids, vasopressors, bronchodilators, oxygen, and emergency equipment on standby in case of serious hypersensitivity reaction.

Generic Name: Ciprofloxacin hydrochloride Brand Name: Ziprocap Dosage: 500 mg/cap, BID Drug Classes: * Antibacterial Therapeutic actions: Bactericidal; interferes with DNA replication in susceptible gram-negative bacteria preventing cell reproduction. Indications: * For the treatment of infections caused by susceptible gram-negative bacteria, including E. coli, P. mirabilis, K. pneumoniae, Enterobacter cloacae, P. vulgaris, P. rettgeri, M. morganii, P. aeruginosa, Citrobacter freundii, S. aureus, S. epidermidis, group D streptococci * Treatment of acute otitis externa (otic) * Treatment of chronic bacterial prostatitis * Unlabeled use: effective in patients with cystic fibrosis who have pulmonary exacerbations Contraindications/cautions: * Contraindications: allergy to ciprofloxacin, norfloxacin, pregnancy, lactation. * Use cautiously with renal dysfunction, seizures. Adverse Effects: * CNS: Headache, dizziness, insomnia, fatigue, somnolence, depression, blurred vision * GI: Nausea, vomiting, dry mouth, diarrhea, abdominal pain * Hematologic: Elevated BUN, SGOT, SGPT, serum creatinine and alkaline phosphatase; decreased WBC, neutrophil count, Hct * Other: Fever, rash

Nursing Responsibilities * Arrange for culture and sensitivity tests before beginning therapy. * Continue therapy for 2 d after signs and symptoms of infection are gone. * Give oral drug 1 h before or 2 h after meals with a glass of water. * Ensure that patient is well hydrated. * Give antacids at least 2 h after dosing. * Monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and sensitivity. * Encourage patient to complete full course of therapy. Drug-specific teaching points: * Take oral drug on an empty stomach--1 h before or 2 h after meals. If an antacid is needed take it at least 2 h before or after dose. * Drink plenty of fluids while you are on this drug. * Know that the following side effects may occur: nausea, vomiting, abdominal pain (small, frequent meals may help); diarrhea or constipation; drowsiness, blurring of vision, dizziness (observe caution if driving or using dangerous equipment). * Report rash, visual changes, severe GI problems, weakness, tremors.