Glyburide:

Therapeutic: antidiabetic effect: lowers blood sugars Indications: controls blood glucose in type 2 diabetes, requires some pancreatic function. Actions: decreases blood glucose levels by stimulating the release of insulin from pancreas and increases sensitivity to insulin at receptor sites. Absorption: well absorbed after oral administration. Distribution: increased concentration in bile and crosses placenta. Protein binding: 99% Metabolism/Excretion: metabolized by liver Half life: 10 hrs Onset: 45-60 min. Peak: 1.5-3 hrs Duration: 24 hrs ***Elderly: increased sensitivity, potential for dosage reduction; renal/hepatic dysfunction increases risk of hypoglycemia; infection, surgery, trauma may alter requirements for control of blood glucose levels. Averse reactions/Side effects: Photosensitivity, hypoglycemia, aplastic anemia. Interactions: Drug-drug Flouroquinolones may increase effects. Warfarin may alter the response to both agents (increase effects of both initially, then decrease activity). PO Geriatric patients: 1.25 mg/day initially, may be increased by 2.5 mg/day at weekly intervals. Assessment: monitor CBC periodically during therapy. Report decrease in blood counts promptly. Observe for hypoglycemic signs and symptoms toxicity/overdose. Implementation: Accidental administration can result in serious harm or death.

Ciprofloxacin:
Therapeutic: Anti-infective effect: death of susceptible bacteria Indications: Treatment of bacterial infections: UTIs including cystitis and prostatitis. Actions: Inhibit bacterial DNA synthesis by inhibiting DNA gyrase. Absorption: Well absorbed after oral administration. Is decreased if taken with dairy products. Distribution: Widely distributed. High tissue and urinary levels are achieved. Metabolism/Excretion: 15% metabolized by the liver, 40-50% excreted unchanged by the kidneys. Half-life: 4 hrs Onset: Rapid Peak: 1-2 hrs Duration: 12 hrs Contraindications: Hypersensitivity. Cross sensitivity among agents within class may occur. ****Geriatric patients: increased risk of adverse reactions. Adverse reactions/Side Effects: Seizures, dizziness, headache, insomnia, diarrhea, nausea, anaphylaxis, Stevens-Johnson syndrome. Interactions: Drug-drug increased risk of QTc prolongation and life-threatening arrhythmias with concurrent use of amiodarone, disopyramide erythromycin, pentamidine, phenothiazines, procainamide, quinidine, sotalol and tricyclis antidepressants. Drug-natural products Fennel decreases the absorption. Dosage (PO adults): Most infections 500-750 mg q 12 hrs. Complicated UTIs 500 mg q 12 hrs 7-14 days. Uncomplicated UTIs 250 mg q 12 hrs 3 days. Renal Impairment: CCr 30-50 ml/min 250-500 mg q 12 hrs. CCr 5-29 ml/min 250-500 mg q 18

hr (immediate-release) or 500 mg q 24 hrs (extended release). Assessment: Observe S&S of anaphylaxis and notify physician immediately if these S&S occur. Implementation: 5% and 10% oral suspension should not be administered through a feeding tube. Shake solution for 15 seconds before administration.

Sinemet CR 100/25 (AKA Carbidopa/Levodopa):

Therapeutic: Anti-Parkinson agents Effects: Relief of tremor and rigidity in Parkinson's syndrome. Action: Converts to dopamine in the CNS where is serves as a neurotransmitter. Carbidopa, a decarboxylase inhibitor, prevents peripheral destruction of Levodopa. Absorption: Well absorbed following oral administration. Distribution: Widely distributed. Levodopa enters the CNS in small concentrations. Carbidopa does not cross blood brain barrier. Metabolism/Excretion: Levodopa is mostly metabolized by the GI tract and liver. Carbidopa is 30% excreted unchanged by the kidneys. Half-life: Levodopa 1 hr, Carbidopa 1-2 hrs Onset: Levodopa 10-15 mins, Carbidopa: Unknown Peak: Unknown for both Duration: Levodopa 5-24 hr+, Carbidopa 5-24 hrs Contraindications: Hypersensitivity, angle closure glaucoma, MAO inhibitor therapy; malignant melanoma, undiagnosed skin lesions. Precautions: Use cautiously in history of cardiac, psychiatric or ulcer disease. Adverse Reactions: Involuntary movements, nausea and vomiting. Interactions: Drug-drug MAO inhibitors may result in hypertensive reactions. Increased risk of arrhythmias with inhalation hydrocarbon anesthetics. Dosage: 25 mg Carbidopa/100mg Levodopa 3-4 times/day, may be increased every 1-2 day until desired effect is achieved. Assessment: Toxicity/Overdose (involuntary muscle twitching, facial grimacing, behavioural change. Implementation: Should not be crushed or chewed. Can be halved.

Docusate Sodium:
Therapeutic: Laxative Effect: Softening and passage of stool. Indications: Prevention of constipation (in patients who should avoid straining, such as after MI or rectal surgery). Action: Promotes incorporation of water into stool, resulting in softer fecal mass. May also promote electrolyte and water secretion into the colon. Absorption: Small amounts may be absorbed from the small intestine after oral administration. Distribution: Unknown. Metabolism/Excretion: Amounts absorbed after oral administration are eliminated in bile. Half-life: Unknown. Onset: 24-48 hrs(up to 3-5 days) Peak: Unknown Duration: Unknown Contraindications: Hypersensitivity, abdominal pain, nausea, or vomiting. Precautions: Excessive or prolonged use may lead to dependence. Should not be used if prompt results are desired. Adverse reactions/Side effects: Throat irritation, mild cramps, rashes. Interactions: none significant. Dosage: PO 50-400 mg in 1-4 divided doses. Assessment: Assess for abdominal distention, presence of bowel sounds and usual pattern of bowel function. Assess colour, consistency and amount of stool produced. Implementation: Administer with a full glass of water or juice. May be administered on an empty stomach for more rapid results.

Budesonide:
Therapeutic: Antiasthmatics, corticosteroids. Effects: Decreased frequency and severity of asthma attacks. Improves asthma symptoms. Indications: Maintenance treatment of asthma as prophylactic therapy. May decrease the need for or eliminate use of systemic corticosteroids in patients with asthma. Action: Potent, locally acting anti-inflammatory and immune modifier. Absorption: 39% (turbuhaler), 6-13% (Flexhaler), 6% (Respules). Distribution: 10-25% is deposited in airways if a spacer device is not used. Metabolism/Excretion: Metabolized by the liver after absorption from lungs. 60% excreted in urine, 40% excreted in feces. Half-life: 2-3.6 hrs Onset: within 24 hrs Peak: 1-4 wk Duration: Unknown Adverse Reactions/Side Effects: Headache, dysphonia, hoarseness, Churg-Strauss syndrome. Interactions: Ritonavir, Itraconazole, clarithromycin and erythromycin increase levels of budesonide. Dosage: Previously on bronchodilators alone 200-400 mcg (1-2 inhalations) TID (not to exceed 2 inhalations twice daily). Previously on other inhaled corticosteroids 200-400 mcg (12 inhalations) TID (not to exceed 4 inhalations twice daily). Previously on oral corticosteroids 400-800 mcg (2-4 inhalations) TID (not to exceed, 4 inhalations twice daily). Assessment: Monitor respiratory status and lung sounds. Implementation: Allow at least 1 min between inhalations. Gradually decrease dosages to lowest possible to control symptoms.

Ventolin:
Therapeutic: Bronchodilator Indications: Used to control and prevent reversible airway obstruction caused by asthma or COPD. Used as a long-term control agent in patients with chronic/persistent bronchospasm. Action: Binds to beta2-adrenergic receptors in airway smooth muscle, leading to activation of adenyl cyclase and increased levels of cAMP. Absorption: Well absorbed after oral administration but rapidly undergoes extensive metabolism. Distribution: Small amounts appear in breast milk. Metabolism/Excretion: Extensively metabolized by the liver and other tissues. Half-life: Orally 2.7-5 hrs Onset: 15-30 mins Peak: 2-3 hrs Duration: 4-6 hrs + Contraindications: Hypersensitivity to adrenergic amines; Hypersensitivity to fluorocarbons (some inhalers). Precautions: Geri Increased risk adverse reaction; may require dosage reduction. Adverse Reactions/Side Effects: Nervousness, restlessness, tremor, chest pain, palpitations. Interactions: MAO inhibitors may lead to hypertensive crisis. Beta blockers may negate therapeutic effect. May decrease serum digoxin levels. Use with caffeine increases stimulant effect. Dosage: PO (Geri) Initial dose should not exceed 2 mg 3-4 times daily, may be increased carefully (up to 32 mg/day). Assessment: Assess lung sounds, pulse and BP before administration and during peak of medication. Note amount, colour and character of sputum produced. Implementation: Extended release tablets should be swallowed whole; do not break, crush or chew.