PIPERACILLIN TAZOBACTAM SODIUM CLASSIFICATION: Antibiotic INDICATIONS piperacillin/tazobactam consists of a semi-synthetic penicillin and a beta-lactamase inhibitor.

. Tazobactam enhances and extends the antibiotic spectrum of piperacillin to include beta-lactamase producing bacteria normally resistant to piperacillin indicated for the treatment of moderate to severe infections caused by susceptible strains of bacteria restricted to Infectious Diseases Service or for organisms resistant to ticarcillin-clavulanate (TIMENTIN) RECONSTITUTION AND STABILITY reconstituted solution should not be stored longer than 12 hours at room temperatuare and 24 hours in refrigerator for IV use: reconstitute each 1 g piperacillin with 5 mL sterile water for injection or NS: ie. reconstitute 2g/0.25g piperacillin/tazobactam vial with 10mL, 3g/0.375g vial with 15mL, and 4g/0.5g vial with 20mL sterile water for injection or NS to give a piperacillin concentration of 1g/5.8mL COMPATIBILITY compatible with sterile water for injection, D5W, D5S, NS

compatible via Y-site with aminophylline, calcium gluconate,

clindamycin, cotrimoxazole, diphendramine, dopamine, fluconazole, furosemide, heparin, hydrocortisone, hydromorphone, lorazepam, magnesium sulfate, meperidine, methylprednisolone, metoclopramide, metronidazole, morphine, MVI, ondansetron, potassium chloride, potassium phosphate, ranitidine incompatible in solutions containing only sodium bicarbonate incompatible with Ringers Lactate Solution do not administer at same time as aminoglycosides due to in vitro inactivation of the aminoglycoside do not mix with other drugs in the same container

ROUTES OF ADMINISTRATION IV intermittent - dilute dose in 50 mL of a compatible IV solution and administer over 30 minutes DOSAGE Adults: Moderate-severe systemic infections: 4g/0.5g q6-8h (12-16g piperacillin/day)

Dosage must be reduced in renal impairment: Creatinine Clearance (mL/min) > 50 30-50 < 30 Hemodialysis/CAPD Dosage 4g/0.5g every 6-8 hours 3g/0.375g every 6-8 hours 2g/0.25g every 6-8 hours 2g/0.25g every 8 hours

when administered concomitantly with an aminoglycoside,

space the doses at least one hour apart

hemodialysis removes 50% of the drug in 4 hours;

administer dose post dialysis

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION anaphylaxis, rash, pruritis thrombophlebitis IMPORTANT IMPLICATIONS use with caution in patients with a history of allergic reactions to penicillins or cephalosporins common adverse effects include nausea, vomiting, diarrhea, headache, insomnia may cause increase in hepatic enzymes and serum creatinine hematological abnormalities include leukopenia, eosinophilia, thrombocytopenia, anemia and prolongation of prothrombin time contains 2.35 mmol sodium (2.35 mEq, 54 mg) per gram of piperacillin

ERTAPENEM Drug classes: Antibiotic, Methyl-carbapenem Therapeutic actions: Bactericidal: Inhibits synthesis of susceptible bacterial cell wall causing cell death. Indications Community-acquired pneumonia caused by Streptococcus pneumoniae (penicillinsusceptible strains only), Haemophilus influenzae (beta-lactamase-negative strains only), Moraxella catarrhalis Skin and skin structure infections including diabetic foot infections without osteomyelitis caused by Staphylococcus aureus (methicillin-susceptible strains only),Streptococcus pyogenes, Escherichia coli, Peptostreptococcus species Complicated GU infections, including pyelonephritis caused by E. coli or Klebsiella pneumoniae Complicated intra-abdominal infections due to E. coli, Clostridium clostridiiforme, Eubacterium lentum, Peptostreptococcus species, Bacteroides fragilis, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides uniformis Acute pelvic infections, including postpartum endomyometritis, septic abortion, post-surgical gynecologic infections due to Streptococcus agalactiae, E. coli, Bacteroides fragilis, Porphyromonas asaccharolytica, Peptostreptococcus species, Prevotella bivia Prophylaxis of surgical-site infection after elective colorectal surgery in adults

Contraindications and cautions Contraindicated with allergies to any component of the drug and to beta lactam antibiotics; allergy to amide-type local anesthetics (IM use); allergy to penicillins, cephalosporins, other allergens. Use cautiously with pregnancy; lactation, seizure disorder. Available forms: Vials for reconstitution1 g/vial Dosages Adults and children 13 yr and older 1 g IM or IV each day; length of treatment varies with infectionintra-abdominal, 5-14 days; urinary tract, 10-14 days; skin and skin structure, 7-14 days; communityacquired pneumonia, 10-14 days; acute pelvic infections, 3-10 days. Prophylaxis: 1 g IV 1 hr before surgical incision. Pediatric patients 3 mo to 12 yr 15 mg/kg IV or IM bid for 3-14 days. Patients with renal impairment For creatinine clearance of 30 mL/min or less, use 500 mg IV or IM daily. Excretion: Urine, unchanged IV FACTS Preparation: Reconstitute 1-g vial with 10 mL of water for injection, 0.9% sodium chloride injection or bacteriostatic water for injection; do not dilute with diluents containing dextrose. Shake well to dissolve and transfer to 50 mL of 0.9% sodium chloride injection; use within 6 hr of reconstitution, or store

refrigerated for up to 24 hr, but use within 4 hr of removal from refrigeration; inspect solution for particulate matter. Infusion: Infuse over 30 min. Incompatibilities: Do not mix in solution or in the same line as any other medications or any solution containing dextrose. Adverse effects CNS: Headache, dizziness, asthenia, fatigue, insomnia, altered mental status, anxiety, seizures CV: Heart failure, arrhythmias, edema, swelling, hypotension, hypertension, chest pain GI: Nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, pseudomembranous colitis, liver toxicity, GERD GU: Vaginitis Hypersensitivity: Ranging from rash to fever to anaphylaxis; serum sickness reaction Local: Pain, phlebitis, thrombophlebitis, inflammation at IV site Respiratory: Pharyngitis, rales, respiratory distress, cough, dyspnea, rhonchi Other: Fever, rash, vaginitis Assessment History: Allergies to any component of the drug and to betalactam antibiotics; allergy to amide-type local anesthetics (IM use), penicillins, cephalosporins, other allergens; pregnancy, lactation, seizures

Physical: T, skin status, swelling, orientation, reflexes, R,

adventitious sounds, P, BP, peripheral perfusion, culture of affected area, sensitivity tests Interventions Culture infected area and arrange for sensitivity tests before beginning drug therapy and during therapy if expected response is not seen. Prepare IM solution as follows: Reconstitute 1-g vials with 3.2 mL of 1% lidocaine injection without epinephrine; shake to form solution; immediately withdraw contents for injection. Administer IM injections deeply into large muscle mass within 1 hr of reconstitution. Warning Discontinue drug if hypersensitivity reaction occurs. Monitor injection site for adverse reactions. Ensure ready access to bathroom facilities and provide frequent small meals if GI complications occur. Arrange for treatment of superinfections if they occur. Teaching points You may experience these side effects: Nausea, diarrhea, dizziness, headache (consult your health care provider if any of these are severe). Report severe diarrhea, difficulty breathing, unusual tiredness or fatigue, pain at injection site.

OMEPRAZOLE Class: antiulcer agents : proton pump inhibitors Trade name: Prilosec Pharmacologic Action of the Drug:. Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. Indication: Management of GERD Management of duodenal ulcers (with or without antiinfectives for H. pylori) Treatment of pathologic hypersecretory conditions, including Zollinger-Ellison syndrome. Contraindicated in: Hypersensitivity. Use Cautiously in: Liver disease (dosage reduction may be necessary) Pregnancy, lactation, or children (safety not established). Adverse Reactions: CNS: dizziness, drowsiness, fatigue, headache, weakness. CV: chest pain. GI: abdominal pain, acid regurgitation, constipation, diarrhea, flatulence, nausea, vomiting.

Derm: itching, rash. Misc: allergic reactions. Desired Action: Decrease in abdominal pain or prevention of gastric irritation and bleeding. Healing of duodenal ulcers can be seen on xray examination or endoscopy Decrease in symptoms of GERD. Therapy is continued for 48 wk after initial episode. Nursing Responsibilities/Precaution: Assess patient routinely for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.

CEFTRIAXONE: anti-infectives:Cephalosporin, 3rd generation Pharmacologic Action of the Drug: Bind to the bacterial cell wall membrane, causing cell death Indication: Treatment of: Skin and skin structure infections Bone and joint infections Urinary and gynecologic infections including gonorrhea or respiratory tract infections Intra-abdominal infections Septicemia Otitis media (cefdinir) Perioperative prophylaxis Endocarditis Lyme disease Contraindications: Hypersensitivity to cephalosporins Serious hypersensitivity to penicillins Hypersensitivity to L-arginine (Ceptaz formulation only) Carnitine deficiency or inborn errors of metabolism (cefditoren only) Use Cautiously in:

Severe hepatic/biliary impairment Combined severe hepatic and renal impairment History of GI disease, especially colitis Geriatric patients Pregnancy and lactation
Adverse Reactions: CNS: SEIZURES(high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, cramps, pseudolithiasis (ceftriaxone). Derm: rashes, urticaria. Hemat: bleeding (increased with cefoperazone), blood dyscrasias, hemolytic anemia. Local: painat IM site, phlebitisat IV site. Misc: allergic reactions includingANAPHYLAXIS andSERUM SICKNESS, superinfection Desired Action: Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection Decreased incidence of infection when used for prophylaxis.

Renal impairment

Nursing Responsibilities/Precaution: Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy. Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction

DIPHENHYDRAMINE Pharmacologic Action of the Drug: Antagonizes the effects of histamine at H1-receptor sites; does not bind to or inactivate histamine Significant CNS depressant and anticholinergic properties. Indication: Relief of allergic symptoms caused by histamine release including: Anaphylaxis Seasonal and perennial allergic rhinitis Allergic dermatoses Parkinson's disease and dystonic reactions from medications Mild nighttime sedation Prevention of motion sickness Contraindicated in: Hypersensitivity Acute attacks of asthma Lactation Known alcohol intolerance (some liquid products). Adverse Effect: CNS: drowsiness, dizziness, headache, paradoxical excitation (increased in children). EENT: blurred vision, tinnitus. CV: hypotension, palpitations. GI: anorexia, dry mouth, constipation, diarrhea.

GU: dysuria, frequency, urinary retention. Derm: photosensitivity. Local: pain at IM site.
Desired Action: Prevention of or decreased urticaria in anaphylaxis or other allergic reactions Decreased dyskinesia in parkinsonism and extrapyramidal reactions Sedation when used as a sedative/hypnotic Prevention of or decrease in nausea and vomiting caused by motion sickness Decrease in frequency and intensity of cough without eliminating cough reflex. Nursing Responsibilities/ Precaution Cough Suppressant: Assess frequency and nature of cough, lung sounds, and amount and type of sputum produced. Unless contraindicated, maintain fluid intake of 15002000 ml daily to decrease viscosity of bronchial secretions. Pruritus: Assess degree of itching, skin rash, and inflammation. Prevention and Treatment of Anaphylaxis: Assess for urticaria and for patency of airway. Allergic Rhinitis: Assess degree of nasal stuffiness, rhinorrhea, and sneezing.

CIPROFLOXACIN Bactericidal: interferes with DNA replication in susceptible bacteria preventing cell production Indications: Severe complicated UTIs; mild to moderate bone and joint infections Chronic bacterial prostatitis Complicated intra-abdominal infections Acute uncomplicated cystitis Mild to moderate acute sinusitis Empirical therapy in febrile neutropenic patients Contraindications: Patients sensitive to fluoroquinolones Adverse reactions: CNS: headache, dizziness, insomnia, fatigue, somnolence, depression, blurred vision CV: arrhythmias, hypotension, angina EENT: dry eye, eye pain, keratopathy GI: nausea, vomiting, dry mouth, diarrhea, abdominal pain Hematologic: elevated BUN, AST, ALT, serum creatinine and alkaline phosphatase; decreased WBC, neutrophil count, HCT Other: fever, rash

Nursing Responsibilities: Treatment of (possible) infections; no more signs and symptoms of infection Give oral forms 2 hours after a meal or 2 hours before or after taking antacids, sucralfate, or products that contain iron. Food doesnt affect absorption but may delay peak serum levels. Monitor patients intake and output and observe for signs of crystalluria. Long-term therapy may result in overgrowth of organisms resistant to ciprofloxacin.

Vitamin K Phytomenadione: Serves as the precursor for coagulation factors synthesized by the liver. Indications: Client with hypoprothrombobinemia tendency to bleed prevent hemorrhagic disease of newborn Vitamin K deficiency Contraindications: hypersensitivity to benzyl alcohol Adverse Reactions: GI- Can upset the stomach, SENSORY- can cause abnormal taste DERMAL- rashes, flushing, urticaria Desired Action: Increase the chance of liver absorption of Vitamin K. The liver is the organ that produces the clotting/ coagulation factors

Nursing Responsibilities: Assess the bleeding and notify MD if signs of bleeding and hypervolemia develop (decreased urine output, restlessness and anxiety, weakness) Monitor patients vital signs Check if patient is on any anticoagulants such as warfarin which may cancel out Vit Ks effects. Check patients PT/PTT test

FAMOTIDINE Histamine 2 receptor antagonist Pharmacologic Action: Competitvely blocks the action of histamine at the H2 receptors of the parietal cells of the stomach, inhibits basal gastric acid secretion and chemically induced gastric acid secretion Indications:

GI: diarrhea, constipation, anorexia, abdominal pain Other: muscle cramp, increase in total bilirubin, sexual impotence As the client's activity is restricted, she may be at risk for developing cosntipation.

Short term therapy and maintenance of duodenal ulcer Short term treatment of benign gastric ulcer Treatment of pathologic hyperseceretory conditions Short term treatment of GERD, esophagitis d/t GERD OTC: relief of symptoms of heartburn, indigestion, sour stomach

Nursing Considerations: Tell client she may experience these side effects: constipation or diarrhea, loss of libido or impotence, headache Ask client to report sore throat, unusual bruising or bleeding, severe headache, muscle or joint pain.

Contraindications: Allergy to famotidine renal failure lactation Use cautiously with pregnancy Adverse Effects: CNS: Headache, malaise, dizziness, somnolence, insomnia Dermatologic: Rash

METRONIDAZOLE Therapeutic Action: Bactericidal: Inhibits DNA synthesis in specific (obligate) anaerobes, causing cell death; antiprotozoaltrichomonocidal, amebicidal Indications: Acute infection with susceptible anaerobic bacteria Acute intestinal amebiasis, Amebic liver abscess Trichomoniasis (acute and partners of patients with acute infection) Bacterial vaginosis Preoperative, intraoperative, postoperative prophylaxis for patients undergoing colorectal surgery Topical application: 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); infected decubitis ulcers, perioral dermatitis Contraindications: Contraindicated with hypersensitivity to metronidazole; pregnancy (not given for trichomoniasis in first trimester) Use cautiously with CNS diseases, hepatic disease, candidiasis (moniliasis), blood dyscrsias, lactation 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, incontinenece, darkening of the urine Local: Thromboplebitis (IV); redness, burning, dryness, and
skin irritation (topical)

Other: Severe, disulfiram-like interaction (flushing,

tachycardia, nausea and vomiting) with alcohol, candidiasis (superinfection) Nursing Considerations: Avoid use unless needed. May be carcinogenic. Administer oral doses with food. Apply topically after cleansing the area. Reduce dosage in hepatic disease. Instruct client to not drink alcohol (beverages or preparations containing alcohol, cough syrups) for 24-72 hr of drug use; severe reactions may occur. Inform client that her urine may be a darker color than usual; this is expected. Warn patient of the side effects: Dry mouth with strange metallic taste (frequent mouth care, sucking sugarless candies may help); nausea, vomiting, diarrhea (eat frequent small meals). Instruct client to report severe GI upset, dizziness, unusual fatigue or weakness, fever, chills.

CEFUROXIME Therapeutic Action: Kills bacteria by binding to their cell wall Indications Oral: Bone & joint infections, meningitis, bronchitis, peritonitis, pharyngitis, sinusitis, otitis media, gonorrhea, Lyme disease Prophylaxis for abdominal operation Septicemia, UTIs Parenteral Lower respiratory infections Dermatologic infections UTIs Uncomplicated and disseminated gonrrhea Septicemia caused by Streptococcus pneumoniae Meningitis Bone and joint infections Perioperative prophylaxis Contra-indications Reactivity to cephalosporins or penicillins Use causiously with renal failure, lactation, pregnancy Adverse Effects: Skin rashes,fever

BLOOD- eosinophilia, Hypothrombopenia/platelet dysfunction Nephrotoxicity, acute renal tubular necrosis Hemolytic anemia, Neutropenia GI- Diarrhea, Pseudomembrenous colitis Increased doses can cause seizures
Nursing Responsibilities: Is patient hypersensitive to cephalosporins and/or penicillins Monitor patient renal & hematologic profile Assess for infection, WBC increase tachycardia, respiratory syndromes, etc. Check for signs of anaphylaxis such as rashes , pruritus,, wheezes and laryngeal edema, etc. IV Preparation: Reconstitute parenteral drug with sterile water for injection, D5W, O.9%NaCl or any of the ff: ).9% NaCl, 5% or 10% dextrose injection, 5%dextrose and 0.45% or 0.9%NaCl in injection. Do not mix with IV solutions containing aminoglycosides. Infusion: Inject slowly over 3-5mins directly into vein for IV administration or infuse over 30min.