ondansetron (on-dan-se-tron)

Zofran, Zofran ODT, Zuplenz

Classification
Therapeutic: antiemetics
Pharmacologic: 5-HT3 antagonists
Pregnancy Category B
Indications
Prevention of nausea and vomiting associated with highly or moderately emetogenic
chemotherapy. PO: Prevention of nausea and vomiting associated with radiation therapy. Prevention
and treatment of postoperative nausea and vomiting.
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Orally disintegrating tablets contain aspartame and should not
be used in patients with phenylketonuria; Congenital long QT syndrome; Concurrent use of
apomorphine.
Use Cautiously in: Hepatic impairment (daily dose not to exceed 8 mg); Abdominal surgery (may
mask ileus); OB/Lactation/Pedi: Pregnancy, lactation, or children 3 yr (PO) or <1 mo (parenteral)
(safety not established) .
Adverse Reactions/Side Effects
CNS: headache, dizziness, drowsiness, fatigue, weakness. CV: TORSADE DE POINTES, QT interval
prolongation. GI: constipation, diarrhea, abdominal pain, dry mouth, liver
enzymes.Neuro: extrapyramidal reactions.
Route/Dosage
IV (Adults): Prevention of chemotherapy-induced nausea/vomiting0.15 mg/kg 1530 min prior to
chemotherapy, repeated 4 and 8 hr later, or 32-mg single dose 30 min prior to chemotherapy (lower
doses have been used).
IM, IV (Adults): Prevention of postoperative nausea/vomiting4 mg before induction of anesthesia or
postoperatively
IV Administration
pH: 3.34.0.
Direct IV: Administer undiluted (2 mg/mL) immediately before induction of anesthesia or
postoperatively if nausea and vomiting occur shortly after surgery.Rate: Administer over at least
30 sec and preferably over 25 min.
Intermittent Infusion: Diluent: Dilute doses for prevention of nausea and vomiting associated
with chemotherapy in 50 mL of D5W, 0.9% NaCl, D5/0.9% NaCl, D5/0.45% NaCl. Solution is
clear and colorless. Stable for 7 days at room temperature following dilution.Concentration: 1
mg/mL.Rate: Administer each dose over 15 min.
Y-Site Incompatibility: acyclovir, allopurinol, aminophylline, amphotericin B cholesteryl,
amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, ampicillin,
ampicillin/sulbactam, amsacrine, azathioprine, cefepime, cefoperazone, chloramphenicol, dantrolene,
diazoxide, ertapenem, furosemide, ganciclovir, indomethacin, lorazepam, methohexital, micafungin,
milrinone, pantoprazole, pemetrexed, pentobarbital, phenobarbital, phenytoin, sargramostim, sodium
bicarbonate, thiopental, trastuzumab, trimethoprin/sulfamethoxazole

levofloxacin (le-voe-flox-a-sin)
Levaquin
Classification
Therapeutic: anti-infectives
Pharmacologic: fluoroquinolones
Pregnancy Category C
Indications
PO, IV: Treatment of the following bacterial infections: : Urinary tract infections, including cystitis,
pyelonephritis, and prostatitis, , Respiratory tract infections, including acute sinusitis, acute
exacerbations of chronic bronchitis, community-acquired pneumonia, and nosocomial pneumonia, ,
Uncomplicated and complicated skin and skin structure infections. Post-exposure treatment of
inhalational anthrax.
Contraindications/Precautions
Contraindicated in: Hypersensitivity (cross-sensitivity within class may exist); QTc interval
prolongation; Uncorrected hypokalemia or hypomagnesemia; Concurrent use of Class IA
antiarrhythmics (disopyramide, quinidine, procainamide) or Class III antiarrhythmics (amiodarone,
sotalol) (risk of QTc interval prolongation and torsade de pointes); History of myasthenia gravis (may
worsen symptoms including muscle weakness and breathing
problems); OB: Pregnancy. Lactation: Not recommended.
Use Cautiously in: Known or suspected CNS disorder; Renal impairment (dose recommended if CCr
50 mL/min); Cirrhosis; Concurrent use of corticosteroids ( risk of tendonitis/tendon rupture);
Kidney, heart, or lung transplant patients ( risk of tendonitis/tendon rupture); Dialysis patients ( risk
of adverse reactions); Geri: risk of adverse reactions; Pedi: Children <18 yr [except for inhalational
anthrax (post-exposure)];
Adverse Reactions/Side Effects (CAPITALS indicate life-threatening;underlines indicate most
frequent.)
CNS: ELEVATED INTRACRANIAL PRESSURE (INCLUDING PSEUDOTUMOR
CEREBRI), SEIZURES, agitation, anxiety, confusion, depression, dizziness, drowsiness,
hallucinations, headache, insomnia, nightmares, paranoia, tremor. CV: TORSADE DE POINTES, QT
interval prolongation.GI: HEPATOTOXICITY, PSEUDOMEMBRANOUS COLITIS, nausea,
abdominal pain, diarrhea, vomiting. GU: vaginitis. Derm: STEVENS-JOHNSON SYNDROME,
photosensitivity, rash.Endo: hyperglycemia, hypoglycemia. Local: phlebitis at IV
site. Neuro: peripheral neuropathy.MS: arthralgia,
IV Administration
Intermittent Infusion: Diluent: Dilute with 0.9% NaCl, D5W, or dextrose/saline
combinations. Also available in premixed bottles and flexible containers with D5W, which need
no further dilution.Concentration: 5 mg/mL. Discard unused solution. Diluted solution is stable
for 72 hr at room temperature and 14 days if refrigerated.Rate: Administer by infusion over at
least 60 min for 250 mg or 500 mg doses and over 90 min for 750 mg dose. Avoid rapid bolus
injection to prevent hypotension.
Y-Site Incompatibility: acyclovir, alprostadil, amiodarone, amphotericin B colloidal, amphotericin B
lipid complex, amphotericin B liposome, cefazolin, cefoperazone, cefoxitin, daunorubicin
hydrochloride, diazepam, fluorouracil, furosemide, ganciclovir, heparin, indomethacin, ketorolac,

methotrexate, nitroglycerin, nitroprusside, pantoprazole, pentobarbital, phenytoin,

piperacillin/tazobactam, prochlorperazine, propofol, rituximab, streptozocin, telavancin, thiopental,
trastuzumab
Patient/Family Teaching
Instruct patient to take medication as directed at evenly spaced times and to finish drug
completely, even if feeling better. Take missed doses as soon as possible, unless almost time for
next dose. Do not double doses. Advise patient that sharing of this medication may be
dangerous.
Advise patients to notify health care professional immediately if they are taking theophylline.
Encourage patient to maintain a fluid intake of at least 15002000 mL/day to prevent
crystalluria.
Advise patient that antacids or medications containing calcium, magnesium, aluminum, iron, or
zinc will decrease absorption and should not be taken within 4 hr before and 2 hr after taking
this medication.
May cause dizziness and drowsiness. Caution patient to avoid driving or other activities
requiring alertness until response to medication is known.
Advise patient to notify health care professional of any personal or family history of QTc
prolongation or proarrhythmic conditions such as recent hypokalemia, significant bradycardia,
or recent myocardial ischemia or if fainting spells or palpitations occur. Patients with this s.
Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching
or discharge, loose or foul-smelling stools).
Instruct patient to notify health care professional if fever and diarrhea develop, especially if
stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting
health care professional.
Instruct patient to notify health care professional immediately if rash, jaundice, signs of
hypersensitivity, or tendon (shoulder, hand, Achilles, and other) pain, swelling, or inflammation
occur. If tendon symptoms occur, avoid exercise and use of the affected area. Increased risk in
>65 yr old, kidney, heart and lung transplant recipients, and patients taking corticosteroids
concurrently. Therapy should be discontinued.