aspirin (ass pir in) Apo-ASA (CAN), Aspergum, Bayer, Easprin, Ecotrin, Empirin, EntroAsphen (CAN), Genprin, Halfprin

81, 1/2 Halfprin, Heartline, Norwich, Novasen (CAN), PMS-ASA (CAN), ZORprin Buffered aspirin products: Alka-Seltzer, Ascriptin, Asprimox, Bufferin, Buffex, Magnaprin
Pregnancy Category D Drug classes of aspirin

Contents [hide]
1 Pregnancy Category D Drug classes of aspirin 2 Therapeutic actions of aspirin 3 Indications of aspirin 4 Adverse effects of aspirin 5 Contraindications of aspirin 6 Nursing considerations of aspirin

Antipyretic Analgesic (nonopioid) Anti-inflammatory Antirheumatic Antiplatelet Salicylate NSAID

Therapeutic actions of aspirin

Analgesic and antirheumatic effects are attributable to aspirins ability to inhibit the synthesis of prostaglandins, important mediators of inflammation. Antipyretic effects are not fully understood, but aspirin probably acts in the thermoregulatory center of the hypothalamus to block effects of endogenous pyrogen by inhibiting synthesis of the prostaglandin intermediary. Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation. This effect occurs at low doses and lasts for the life of the platelet (8 days). Higher doses inhibit the synthesis of prostacyclin, a potent vasodilator and inhibitor of platelet aggregation.

Indications of aspirin

Mild to moderate pain

Fever Inflammatory conditionsrheumatic fever, rheumatoid arthritis, osteoarthritis Reduction of risk of recurrent TIAs or stroke in males with history of TIA due to fibrin platelet emboli Reduction of risk of death or nonfatal MI in patients with history of infarction or unstable angina pectoris MI prophylaxis Unlabeled use: Prophylaxis against cataract formation with long-term use

Dosage & Route of aspirin

Available in oral and suppository forms. Also available as chewable tablets, gum; enteric coated, SR, and buffered preparations (SR aspirin is not recommended for antipyresis, shortterm analgesia, or children < 12 yr.)

ADULTS Minor aches and pains: 325650 mg q 4 hr. Arthritis and rheumatic conditions: 3.26 g/day in divided doses. Acute rheumatic fever: 58 g/day; modify to maintain serum salicylate level of 1530 mg/dL. TIAs in men:1,300 mg/day in divided doses (650 mg bid or 325 mg qid). MI prophylaxis: 75325 mg/day. PEDIATRIC PATIENTS Analgesic and antipyretic: 65 mg/kg per 24 hr in four to six divided doses, not to exceed 3.6 g/day. Dosage recommendations by age:

Age (yr) 23 45 68 910 11 12

Dosage(mg q 4 hr) 162 243 324 405 486 648

Juvenile rheumatoid arthritis: 60110 mg/kg per 24 hr in divided doses at 6- to 8-hr intervals. Maintain a serum level of 150300 mcg/mL.

Acute rheumatic fever: Initially, 100 mg/kg/day, then decrease to 75 mg/kg/day for 46 wk. Therapeutic serum salicylate level is 150300 mg/dL. Kawasaki disease: 80180 mg/kg/day; very high doses may be needed during acute febrile period; after fever resolves, dosage may be adjusted to 10 mg/kg/day. Adverse effects of aspirin

Acute aspirin toxicity: Respiratory alkalosis, hyperpnea, tachypnea, hemorrhage, excitement, confusion, asterixis, pulmonary edema, seizures, tetany, metabolic acidosis, fever, coma, CV collapse, renal and respiratory failure (dose related, 2025 g in adults, 4 g in children)

Aspirin intolerance: Exacerbation of bronchospasm, rhinitis (with nasal polyps, asthma, rhinitis) GI: Nausea, dyspepsia, heartburn, epigastric discomfort, anorexia, hepatotoxicity Hematologic: Occult blood loss, hemostatic defects Hypersensitivity: Anaphylactoid reactions to anaphylactic shock Salicylism: Dizziness, tinnitus, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, lassitude (dose related) Contraindications of aspirin

Contraindicated with allergy to salicylates or NSAIDs (more common with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-sensitivity to aspirin is common); hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency (increased risk of bleeding)

Use cautiously with impaired renal function; chickenpox, influenza (risk of Reyes syndrome in children and teenagers); children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy (maternal anemia, antepartal and postpartal hemorrhage, prolonged gestation, and prolonged labor have been reported; readily crosses the placenta; possibly teratogenic; maternal ingestion of aspirin during late pregnancy has been associated with the following adverse fetal effects: low birth weight, increased intracranial hemorrhage,

stillbirths, neonatal death); lactation. Nursing considerations of aspirin Assessment of aspirin History: Allergy to salicylates or NSAIDs; allergy to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency; impaired hepatic function; impaired renal function; chickenpox, influenza; children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy; lactation

Physical: Skin color, lesions; T; eighth cranial nerve function, orientation, reflexes, affect; P, BP, perfusion; R, adventitious sounds; liver evaluation, bowel sounds; CBC, clotting times, urinalysis, stool guaiac, LFTs, renal function tests

Interventions of aspirin BLACK BOX WARNING: Do not use in children and teenagers to treat chickenpox or flu symptoms without review for Reyes syndrome, a rare but fatal disorder. Give drug with food or after meals if GI upset occurs.

Give drug with full glass of water to reduce risk of tablet or capsule lodging in the esophagus. Do not crush, and ensure that patient does not chew SR preparations. Do not use aspirin that has a strong vinegar-like odor. WARNING: Institute emergency procedures if overdose occurs: Gastric lavage, induction of emesis, activated charcoal, supportive therapy.

Teaching points of aspirin Take extra precautions to keep this drug out of the reach of children; this drug can be very dangerous for children.

Use the drug only as suggested; avoid overdose. Avoid the use of other over-the-counter drugs while taking this drug. Many of these drugs contain aspirin, and serious overdose can occur. Take the drug with food or after meals if GI upset occurs. Do not cut, crush, or chew sustained-release products. Over-the-counter aspirins are equivalent. Price does not reflect effectiveness. You may experience these side effects: Nausea, GI upset, heartburn (take drug with food); easy bruising, gum bleeding (related to aspirins effects on blood clotting).

Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult breathing; nausea, vomiting, bloody stools. Generic Name: gentamycin sulfate

Brand Name:

Contents [hide]
1 Brand Name: 2 Classification: 3 Dosage & Route 4 Therapeutic actions 5 Adverse effects 6 Contraindications 7 Nursing considerations

o o o

7.1 Assessment 7.2 Interventions 7.3 Teaching points

Parenteral, intrathecal: Alcomicin (CAN), Garamycin, Pediatric Gentamicin Sulfate Topical dermatologic cream, ointment: Garamycin Ophthalmic: Garamycin, Gentacidin, Gentak, Genoptic, Genoptic S.O.P. Gentamicin impregnated PMMA beads: Septopal Gentamicin Liposome injection: Maitec Aminoglycoside

Classification:
Pregnancy Category D
Dosage & Route

Available forms :Injection10, 40 mg/mL; ophthalmic solution3 mg/mL;ophthalmic ointment 3 mg/g; topical ointment0.1%; topical cream0.1%; ointment1 mg; cream1 mg Parenteral ADULTS

3 mg/kg/day in three equal doses q 8 hr IM or IV. Up to 5 mg/kg/day in three to four equal doses in severe infections. For IV use, a loading dose of 12 mg/kg may be infused over 3060 min, followed by a maintenance dose, usually for 710 days. PID: 2 mg/kg IV followed by 1.5 mg/kg tid plus clindamycin 600 mg IV qid. Continue for at least 4 days and at least 48 hr after patient improves, then continue clindamycin 450 mg orally qid for 10 14 days total therapy. Surgical prophylaxis regimens: Several complex, multidrug prophylaxis regimens are available for preoperative use; consult manufacturers instructions. 22.5 mg/kg q 8 hr IM or IV. Infants and neonates: 2.5 mg/kg q 8 hr. Premature or full-term neonates: 2.5 mg/kg q 12 hr. Reduce dosage or extend time dosage intervals, and carefully monitor serum drug levels and renal function tests.

PEDIATRIC PATIENTS

GERIATRIC PATIENTS OR PATIENTS WITH RENAL FAILURE

Ophthalmic solution ADULTS AND PEDIATRIC PATIENTS

12 drops into affected eye or eyes q 4 hr; use up to 2 drops hourly in severe infections.

Ophthalmic ointment ADULTS AND PEDIATRIC PATIENTS

Apply small amount to affected eye bidtid.

Dermatologic preparations ADULTS AND PEDIATRIC PATIENTS

Apply tid to qid. Cover with sterile bandage if needed.

Therapeutic actions Gentamicin is an aminoglycoside that binds to 30s and 50s ribosomal subunits of susceptible bacteria disrupting protein synthesis, thus rendering the bacterial cell membrane defective.

Indications Parenteral

Serious infections caused by susceptible strains of Pseudomonas aeruginosa, Proteus species, Escherichia coli, Klebsiella-Enterobacter-Serratia species, Citrobacter, Staphylococcus species Serious infections when causative organisms are not known (often in conjunction with a penicillin or cephalosporin) Unlabeled use: With clindamycin as alternative regimen in PID Gram-negative infections Serious CNS infections, such as meningitis, ventriculitis, infections caused by susceptible Pseudomonas species Treatment of superficial ocular infections due to strains of microorganisms susceptible to gentamicin Infection prophylaxis in minor skin abrasions and treatment of superficial infections of the skin due to susceptible organisms amenable to local treatment Orphan drug use: Treatment of chronic osteomyelitis of posttraumatic, postoperative, or hematogenous origin Orphan drug use: Treatment of disseminated Myobacterium avium-intracellulare infection

Intrathecal

Ophthalmic preparations

Topical dermatologic preparation

Gentamicin-impregnated PMAA beads on surgical wire

Gentamicin liposome injection

Adverse effects Dizziness or vertigo; acute renal failure, interstitial nephritis, acute tubular necrosis; electrolyte imbalances; transient elevation of serum bilirubin and aminotransferases; purpura; nausea, vomiting; convulsions, mental depression, hallucinations. Atrophy or rat necrosis at inj sites. Potentially Fatal: Nephrotoxicity, ototoxicity and neuromuscular blockade (may unmask or aggravate myasthaenia gravis). Contraindications History of hypersensitivity to aminoglycoside; pregnancy; hepatic impairment, perforated ear drum. Nursing considerations Assessment History: Allergy to any aminoglycosides; renal or hepatic disease; preexisting hearing loss; active infection with herpes, vaccinia, varicella, fungal infections, myobacterial infections (ophthalmic preparations); myasthenia gravis; parkinsonism; infant botulism; lactation, pregnancy Physical: Site of infection; skin color, lesions; orientation, reflexes, eighth cranial nerve function; P, BP; R, adventitious sounds; bowel sounds, liver evaluation; urinalysis, BUN, serum creatinine, serum electrolytes, LFTs, CBC Interventions Give by IM route if at all possible; give by deep IM injection. Culture infected area before therapy. Use 2 mg/mL intrathecal preparation without preservatives, for intrathecal use. Avoid long-term therapies because of increased risk of toxicities. Reduction in dose may be clinically indicated. Patients with edema or ascites may have lower peak concentrations due to expanded extracellular fluid volume. Cleanse area before application of dermatologic preparations.

Ensure adequate hydration of patient before and during therapy. BLACK BOX WARNING: Monitor hearing with long-term therapy; ototoxicity can occur. BLACK BOX WARNING: Monitor renal function tests, CBCs, serum drug levels during long-term therapy. Consult with prescriber to adjust dosage.

Teaching points Apply ophthalmic preparations by tilting head back; place medications into conjunctival sac and close eye; apply light pressure on lacrimal sac for 1 minute. Cleanse area before applying dermatologic preparations; area may be covered if necessary.

You may experience these side effects: Ringing in the ears, headache, dizziness (reversible; use safety measures if severe); nausea, vomiting, loss of appetite (eat frequent small meals, perform frequent mouth care); burning, blurring of vision with ophthalmic preparations (avoid driving or performing dangerous activities if visual effects occur); photosensitization with dermatologic preparations (wear sunscreen and protective clothing). Report pain at injection site, severe headache, dizziness, loss of hearing, changes in urine pattern, difficulty breathing, rash or skin lesions; itching or irritation (ophthalmic preparations); worsening of the condition, rash, irritation (dermatologic preparation).