CLINDAMYCIN

(Cleocin)

Drug class

Lincosamide antibiotic
Pregnancy Category B

Therapeutic actions

Nursing considerations

Assessment

Inhibits protein synthesis in susceptible bacteria,

causing cell death.

History: Allergy to clindamycin, history of asthma or

other allergies, allergy to tartrazine (in 75- and 150mg capsules); hepatic or renal dysfunction; lactation;
history of regional enteritis or ulcerative colitis;
history of antibiotic associated colitis
Physical: Site of infection or acne; skin color,
lesions; BP; R, adventitious sounds; bowel sounds,
output, liver evaluation; complete blood count, renal
and liver function tests

Indications

Serious infections caused by susceptible strains

of
anaerobes,
streptococci,
staphylococci,
pneumococci; reserve use for penicillin-allergic
patients or when penicillin is inappropriate; less
toxic antibiotics (erythromycin) should be
considered

Contraindications

Contraindicated with allergy to clindamycin,

history of asthma or other
allergies, tartrazine (in 75- and 150-mg
capsules); hepatic or renal dysfunction;
lactation.

Side effects

Local: Pain following injection, induration and

sterile abscess after IM injection,
thrombophlebitis after IV use

CV: Hypotension, cardiac arrest (with rapid IV

infusion)
GI: Severe colitis, including pseudomembranous
colitis, nausea, vomiting, diarrhea, abdominal
pain, esophagitis, anorexia, jaundice, liver
function changes
Hematologic: Neutropenia, leukopenia,
agranulocytosis, eosinophilia
Hypersensitivity: Rashes, urticaria to
anaphylactoid reactions

Interventions

Culture infection before therapy.

Administer oral drug with a full glass of water or with
food to prevent esophageal irritation.
Do not give IM injections of more than 600 mg; inject
deep into large muscle to avoid serious problems.
Do not use for minor bacterial or viral infections.
Monitor renal and liver function tests, and blood
counts with prolonged therapy.

OMEPRAZOLE (Losec,Prilosec)
Drug class

Gastrointestinal agent; proton pump inhibitor

Pregnancy Category C

Therapeutic effects

Suppresses gastric acid secretion relieving

gastrointestinal distress and promoting ulcer
healing.

Report severe diarrhea; drug may need to be

discontinued.

FUROSEMIDE

Indications

Duodenal and gastric ulcer. Gastroesophageal reflux

disease including severe erosive esophagitis (4 to 8
wk treatment). Long-term treatment of pathologic
hypersecretory conditions such as Zollinger-Ellison
syndrome, multiple endocrine adenomas, and
systemic
mastocytosis.
In
combination
with
clarithromycin to treat duodenal ulcers associated
with Helicobacter pylori.

Drug class

Long-term use for gastroesophageal reflux disease,

duodenal ulcers.

Side effects

CNS:Headache, dizziness, fatigue.

GI:Diarrhea, abdominal pain, nausea, mild transient
increases in liver function tests.
Urogenital:Hematuria, proteinuria.
Skin:Rash

Nursing implications

Assessment & Drug Effects

Lab tests: Monitor urinalysis for hematuria and

proteinuria. Periodic liver function tests with
prolonged use.

Patient & Family Education

Report any changes in urinary elimination such as

pain or discomfort associated with urination, or
blood in urine.

Loop diuretic
Pregnancy Category C

Therapeutic effects

Contraindications

(Lasix)

Furosemide inhibits reabsorption of Na and

chloride mainly in the medullary portion of the
ascending Loop of Henle. Excretion of potassium
and ammonia is also increased while uric acid
excretion is reduced. It increases plasma-renin
levels and secondary hyperaldosteronism may
result. Furosemide reduces BP in hypertensives
as well as in normotensives. It also reduces
pulmonary oedema before diuresis has set in.

Indications

Oral, IV: Edema associated with CHF, cirrhosis,

renal disease
IV: Acute pulmonary edema
Oral: Hypertension

Contraindications

Severe sodium and water depletion, hypersensitivity

to sulphonamides and furosemide, hypokalaemia,
hyponatraemia, precomatose states associated with
liver cirrhosis, anuria or renal failure.
Addisons disease.

Side effects

Fluid and electrolyte imbalance.

Rashes, photosensitivity, nausea, diarrhoea,
blurred vision, dizziness, headache,

hypotension. Bone marrow depression (rare),

hepatic dysfunction.
Hyperglycaemia, glycosuria, ototoxicity.
Potentially Fatal: Rarely, sudden death and
cardiac arrest. Hypokalaemia and magnesium
depletion can cause cardiac arrhythmias.

Nursing implications

Assessment

History: Allergy to furosemide, sulfonamides,

tartrazine; electrolyte depletion anuria, severe renal
failure; hepatic coma; SLE; gout; diabetes mellitus;
lactation, pregnancy
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, LFTs, renal function tests, uric
acid, urinalysis, weight

Teaching points

Record intermittent therapy on a calendar or dated

envelopes. When possible, take the drug early so
increased urination will not disturb sleep. Take with
food or meals to prevent GI upset.
Weigh yourself on a regular basis, at the same time
and in the same clothing, and record the weight on
your calendar.
Blood glucose levels may become temporarily
elevated in patients with diabetes after starting this
drug.
You may experience these side effects: Increased
volume and frequency of urination; dizziness, feeling
faint on arising, drowsiness (avoid rapid position
changes; hazardous activities, like driving; and

consumption of alcohol); sensitivity to sunlight (use

sunglasses, wear protective clothing, or use a
sunscreen); increased thirst (suck on sugarless
lozenges; use frequent mouth care); loss of body
potassium (a potassium-rich diet or potassium
supplement will be needed).
Report loss or gain of more than 3 pounds in 1 day,
swelling in your ankles or fingers, unusual bleeding
or bruising, dizziness, trembling, numbness, fatigue,
muscle weakness or cramps.

Ampicillin Sulbactam (Unasyn)

Drug class

antibacterial
Pregnancy Category: B

Therapeutic effects

Bactericidal action against sensitive organisms;

inhibits synthesis of bacterial cell wall, causing
cell death.

Indications

Treatment of skin and skin structure, intraabdominal, and gynecologic infections caused by
susceptible microorganisms.

Contraindications

Hypersensitivity to penicillins.

Side effects

Dermatologic: Rash (less than 2%); erythema

multiforme, exfoliative dermatitis, urticaria.
GI: Diarrhea (3%); black, hairy tongue; Clostridium
difficile associated diarrhea; enterocolitis; gastritis;
pseudomembranous colitis; stomatitis.
Genitourinary: Increased BUN and creatinine;
presence of RBCs and hyaline casts in urine.

Hematologic: Agranulocytosis; decreased Hct, Hgb,

lymphocytes, neutrophils, RBC, platelets, and WBC;
increased basophils, eosinophils, lymphocytes,
monocytes, and platelets; positive direct Coombs
tests.
Hypersensitivity:
Hypersensitivity
(anaphylactic)
reactions (sometimes fatal).
Local: Pain at IM injection site (16%); pain at IV
injection site, thrombophlebitis at injection site (3%).
Metabolic: Elevated serum alkaline phosphatase,
ALT, AST, and LDH; reduced serum albumin and total
proteins.

History: Allergies to penicillins, cephalosporins, or

other allergens; renal disorders; lactation
Physical: Culture infected area; skin color, lesion; R,
adventitious sounds; bowel sounds; CBC, LFTs, renal
function tests, serum electrolytes, Hct, urinalysis

Take this drug around-the-clock.

Take the full course of therapy; do not stop taking
the drug if you feel better.
This antibiotic is specific to your problem and should
not be used to self-treat other infections.
You may experience these side effects: Nausea,
vomiting, GI upset (eat frequent small meals),
diarrhea.
Report pain or discomfort at sites, unusual bleeding
or bruising, mouth sores, rash, hives, fever, itching,
severe diarrhea, difficulty breathing.

D5050
Drug class

Rapidly increases blood glucose levels

Transient osmotic diuretic

Indications

Documented hypoglycemia
Seizures of unknown etiology
Cerebral/meningeal edema related to eclampsia

No significant contraindications in the emergency

setting

Side effects

Pain, phlebitis at injection site

Hyperglycemia and glycosuria
Fluid overload

Special Considerations

Teaching points

Therapeutic effects

Assessment

Caloric Agent

Contraindications

Nursing implications

Rapid rates of administration predisposes the patient

to pain and may cause phlebitis if aperipheral vein is
used; to minimize this effect administer slowly
Excessive IV administration may cause fluid
overload, water intoxication, +/or CHF
D50W and Thiamine 100 mg IV (mini bag or IVP)
should be given together when alcoholism or
malnutrition are suspected

CALCIUM CARBONATE
Drug class

Electrolyte replacement
Supplements
Antacid

Therapeutic effects

Essential for nervous, muscular, and skeletal

systems. Maintain cell membrane and capillary
permeability. Act as an activator in the
transmission of nerve impulses and contraction
of cardiac, skeletal and smooth muscles. It is
essential for bone formation and blood
coagulation. It is also used a replacement of
calcium in deficiency states. It controls of
hyperphosphatemia in end-stage renal disease
without promoting aluminum absorption.

Indications

Hypercalcemia increases the risk of digoxin

toxicity. Chronic use with antacids in renal
insufficiency may lead to milk-alkali syndrome.
Ingestion by mouth may decrease the absorption
of
orally
administered
tetracyclines,
fluoroquinolones, phenytoin, and iron salts.
Excessive amounts may decrease the effects of
calcium channel blockers, atenolol. Concurrent
use with diuretics may result in hypercalcemia.

ATORVASTATIN

CNS: syncope, tingling

CV: cardiac arrest, arrythmias, bradycardia
GI: constipation, nausea, vomting
GU: calculi, hypercalciuruia
Local: phlebitis (IV only)

Monitor VS especially BP and PR

Obtain ECG result.

Dyslipidaemic Agent

Therapeutic effects

Atorvastatin competitively inhibits HMG-CoA

reductase, the enzyme that catalyses the
conversion of HMG-CoA to mevalonic acid. This
results in the induction of the LDL receptors,
leading to lowered LDL-cholesterol
concentration.

Indications

Reduction of risk of stroke and heart attack in

type 2 diabetes patients without evidence of
heart disease but with other CV risk factors, and
revascularization procedures in patients without
evidence of coronary heart disease (CHD) but
with multiple risk factors other than diabetes
(eg, smoking, HTN, low HDL-C, family history of
early CHD) Patients with CHD, to reduce risks of
MI, revascularization procedures, hospitalization
for CHF, and angina

Contraindications

Nursing implications

(Lipitor)

Drug class

Side effects

Asses for heartburn, indigestion, abdominal pain.

Monitor serum calcium before treatment.
Assess for nausea and vomiting, anorexia, thirst,
severe constipation

Hypersensitivity, active liver disease or unexplained

persistent elevations of serum transaminase,
porphyria, pregnancy, lactation.

Side effects

Headache, flatulence, diarrhea, nausea, vomiting,

anorexia,
xerostomia,
angioedema,
myalgia,
rash/pruritus, alopecia, allergy, infection, chest pain

Nursing implications

Contraindications

Stress that atorvastatin is an adjunct to not a

substitute for low-cholesterol diet
Tell patient to take drug at the same time each
day to maintain its effects
Instruct patient to take a missed dose as soon
as possible. If its almost time for his next dose,
he should skip the missed dose.
Advise patient to notify prescriber immediately if
he develops unexplained muscle pain,
tenderness, or weakness, especially if
accompanied by fatigue or fever

(Lanoxin)

Drug class

Cardiac glycoside,
Cardiotonic
Pregnancy Category C

Digoxin is a cardiac glycoside which has positive

inotropic activity characterized by an increase in
the force of myocardial contraction. It also
reduces the conductivity of the heart through
the atrioventricular (AV) node. Digoxin also
exerts direct action on vascular smooth muscle
and indirect effects mediated primarily by the
autonomic nervous system and an increase in
vagal activity.

Indications

Extra beats, anorexia, nausea and vomiting.

Diarrhea in elderly, confusion, dizziness, drowsiness,
restlessness, nervousness, agitation and amnesia,
visual disturbances, gynecomastia, local irritation
(IM/SC inj), rapid IV admin may lead to
vasoconstriction and transient hypertension.
Potentially Fatal: Cardiac arrhythmias in combination
with heart block.

Nursing implications

Assessment

Therapeutic effects

Digitalis toxicity, ventricular tachycardia/fibrillation,

obstructive cardiomyopathy.
Arrhythmias due to accessory pathways (e.g. WolffParkinson-White syndrome).

Side effects

DIGOXIN

CHF
Atrial fibrillation

History: Allergy to digitalis preparations, ventricular

tachycardia, ventricular fibrillation, heart block, sick
sinus syndrome, IHSS, acute MI, renal insufficiency,
decreased K+, decreased Mg2+ increased Ca2+,
pregnancy, lactation
Physical: Weight; orientation, affect, reflexes, vision;
P, BP, baseline ECG, cardiac auscultation, peripheral
pulses, peripheral perfusion, edema; R, adventitious
sounds; abdominal percussion, bowel sounds, liver
evaluation; urinary output; electrolyte levels, LFTs,
renal function tests

Teaching points

Do not stop taking this drug without notifying

your health care provider.

Take pulse rate before administering.

Do not start taking any prescription or over-thecounter products without talking to your health
care provider. Some combinations may increase
the risk of digoxin toxicity and may put you at
risk of adverse reactions.
Report unusually slow pulse, irregular pulse, rapid
weight gain, loss of appetite, nausea, diarrhea,
vomiting, blurred or yellow vision, unusual
tiredness and weakness, swelling of the ankles,
legs or fingers, difficulty breathing.

ACETYLCYSTEINE

(Fluimucil)

Side effects

Drug class

CNS: fever, drowsiness, abnormal thinking, gait

disturbances
CV: tachycardia, hypotension, hypertension,
flushing, chest tightness
EENT: rhinorrhea, ear pain, eye pain, pharyngitis,
throat tightness
GI: stomatitis, nausea, vomiting
Respiratory: rhonchi, bronchospasm, cough,
dyspnea
Skin: rash, clamminess, diaphoresis, pruritus,
urticaria
Other: angioedema, chills, anaphylactoid
reaction

Mucolytic

Therapeutic effects

Mucolytic that reduces the viscosity of

pulmonary secretions by splitting disulfide
linkages
between
mucoprotein
molecular
complexes. Also, restores liver stores of
glutathione to treat acetaminophen toxicity.

Indications

Treatment of respiratory affections characterized

by thick and viscous hypersecretions: acute
bronchitis,
chronic
bronchitis
and
its
exacerbations;
pulmonary
emphysema,
mucoviscidosis and bronchieactasis.

Nursing implications

Assessment & Drug Effects

Contraindications

Known hypersensitivity to acetylcesteine. As

Acetylcysteine (Fluimucil) granules and tablets
contain aspartame, it is contraindicated in
patients suffering from phenylketonuria.

During IV infusion, carefully monitor for fluid

overload and signs of hyponatremia (i.e.,
changes in mental status).
Monitor for S&S of aspiration of excess
secretions,
and
for
bronchospasm
(unpredictable); withhold drug and notify
physician immediately if either occurs.
Lab tests: Monitor ABGs, pulmonary functions
and pulse oximetry as indicated.
Have suction apparatus immediately available.
Increased volume of respiratory tract fluid may
be liberated; suction or endotracheal aspiration
may be necessary to establish and maintain an
open airway. Older adults and debilitated
patients are particularly at risk.
Nausea and vomiting may occur, particularly
when face mask is used, due to unpleasant odor

of drug and excess volume of liquefied bronchial

secretions.

Patient & Family Education

Contraindications

Report difficulty with clearing the airway or any

other respiratory distress.
Report nausea, as an antiemetic may be
indicated.
Note: Unpleasant odor of inhaled drug becomes
less noticeable with continued use.
Do not breast feed while taking this drug without
consulting physician.

Side effects

(Ventolin)

Drug class
Therapeutic effects

It relieves nasal congestion and reversible

bronchospasm by relaxing the smooth muscles
of the bronchioles. The relief from nasal
congestion and bronchospasm is made possible
by the following mechanism that takes place
when Salbutamol is administered.

Indications

Treatment & prevention of bronchial asthma,

bronchitis, emphysema w/ associated reversible
airway obstruction.

Nervousness, Restlessness, Tremor, Headache,

Insomnia, Chest pain, Palpitations, Angina,
Arrhythmias,
Hypertension,
Nausea
and
vomiting, Hyperglycemia, Hypokalemia

Nursing implications

SALBUTAMOL

Hypersensitivity to adrenergic amines

Hypersensitivity to fluorocarbons

Auscultate lungs for presence of adventitious

breath sounds that may signal pulmonary
edema, airway resistance or bronchospasm.
Inspect clients nail bed and oral mucosa for
pallor.
Place client in position of comfort to facilitate
optimum rest and sleep.
Assess pulse for rhythm.
Provide oral care or let patient gurgle after
inhalation to get rid of the unpleasant aftertaste
of the inhalation.