Rose Lea Quiamco RN heals DRUG STUDY Name of Drug Generic Name: cefuroxime sodium Brand Name: Kefurox

Zinacef Classification & Dosage Mechanism of Action

ER/Pedia

Indication Pharyngitis, tonsillitis caused by Streptococcus pyogenes Otitis media caused by Streptococcus pneumoniae, S. pyogenes, Haemophilus influenzae, Moraxella catarrhalis Lower respiratory infections caused by S. pneumoniae Haemophilus parainfluenzae, H. influenzae UTIs caused by Escherichia coli, Klebsiella pneumoniae Uncomplicated

Contraindication Contraindicated in patients hypersensitive to drug or other cephalosporins.

Adverse Effects Phlebitis, Thrombophlebitis , diarrhea, hemolytic anemia

Nursing Responsibilities

Anti-infective drug; A second Cephalosporin generation cephalosporin Adults and that inhibits children age cell-wall 13 and older: synthesis, 250-mg tab promoting P.O. b.i.d. for osmotic 10 days. instability; Children ages usually 3 months to12 bactericidal years: 30 mg/kg/day oral suspension P.O. in two divided doses for 10 days.

Alert: Dont confuse drug with other cephalosporins that sound alike. Oral drug full course of therapy even if you are feeling better. This drug is specific for this infection and should not be used to self-treat other problems. Swallow tablets whole; do not crush them. Take the drug with food. You may experience these side effects: Stomach upset or diarrhea. Report severe diarrhea with blood, pus, or mucus; rash; difficulty breathing; unusual tiredness, fatigue; unusual bleeding or bruising; unusual itching or irritation.
Take

gonorrhea (urethral and endocervical) Dermatologic infections, including impetigo caused by Streptococcus aureus, S. pyogenes Treatment of early Lyme disease Parenteral (cefuroxime sodium) Lower respiratory infections caused by S. pneumoniae, S. aureus, E. coli, Klebsiella, H. influenzae, S. pyogenes Dermatologic infections caused by S. aureus, S. pyogenes, E. coli, Klebsiella, Enterobacter UTIs caused by E. coli, Klebsiella Perioperative prophylaxis Treatment of acute bacterial maxillary sinusitis in patients 3 mo12 yr

Parenteral drug
Avoid alcohol while taking this drug and for 3 days after because severe reactions often occur. You may experience these side effects: Stomach upset or diarrhea. Report severe diarrhea, difficulty breathing, unusual tiredness or fatigue, pain at injection site.

Name of Drug Generic: Paracetamol Brand name: Tyelnol Calpol

Classification & Dosage Anti-pyretic

Mechanism of Action

Indication Temporary relief of pain & discomfort from headache. Fever, cold, flu, minor muscular aches, overexertion, menstrual cramps, toothache, minor arthritic pain

Contraindicati on Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation.

Adverse Effects CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 58 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr Hematologic: Hemolytic anemia, leukopenia, neutropenia, thrombocytopeni a, pancytopenia Hepatic: Liver damage, jaundice Metabolic: Hypoglycemia Skin:Rash, urticuria

Nursing Responsibilities 1) Assess pts allergies & calculate total daily dosage accordingly. 2) Assess pts pain/temperature before therapy . 3) Tell patient that high dose or unsupervised long term use can cause liver damage. 4) Be alert for signs of reactions & drug interactions. 5) Tell patient to keep track of daily drug intake, including OTC & prescription medications. 6) Tell a breast feeding woman thath drug appears in breastmilk in levels less than 1% of dose. 7) Use liquid form for children & patients who have difficulty swallowing. 8) Tell patient to consult prescriber before giving drug to children younger than age 2.

SOURCE: NDH 26th edition, pg 351352

Paracetamol may cause analgesia by inhibiting CNS Non-opiod prostaglandin synthesis. The Availability: mechanism of Pedia PO or action of PR Doses may morphine is be repeated 4 believed to 5 times/day; do involve not exceed five decreased doses in 24 hr; permeability of give PO or by the cell suppository. membrane to sodium, which Age Dosage results in (mg) diminished 03 mo transmission of 40 pain impulses 411 mo therefore 80 analgesia. 1223 mo 120 23 yr 160 45 yr 240 68 yr 320 910 yr 400 11 yr 480

Name of Drug Generic: phenobarbital phenobarbital sodium Brand Name: Oral preparations: Bellatal, Solfoton Parenteral: Luminal Sodium

Classification & Dosage Barbiturate (long acting) Sedative Hypnotic Antiepileptic

Mechanism of Action

Indication Treatment of insomnia for up to 2 wks Long-term treatment of generalized tonic-clonic and cortical focal seizures

Contraindicat ion Severe renal and hepatic disorders. Severe respiratory depression, dyspnea or airway obstruction; porphyria.

Adverse Effects CNS: drowsiness, lethargy, CNS excitation or depression, impaired judgment, hangover effect, confusion, somnolence, agitation, nervousness, headache, insomnia, nightmares, hallucinations, anxiety, dizziness CV: Bradycardia, hypotension, syncope; ataxia, GI: nausea, vomiting, constipation; Hematologic: agranulocytosis, thrombocytopenia, megaloblastic anemia Skin: rash, exfoliative dermatitis

Nursing Responsibilities 1) Assess pts history to hypersensitivity to barbiturates or any seizure disorders. 2) Do not administer intraarterially; may produce arteriospasm, thrombosis, gangrene. 3) Administer IV doses slowly. 4) Administer IM doses deep in a large muscle mass (gluteus maximus, vastus lateralis) or other areas where there is little risk of encountering a nerve trunk or major artery. 5) Monitor injection sites carefully for irritation, extravasation (IV use). Solutions are alkaline and very irritating to the tissues. 6) Monitor P, BP, respiration carefully during IV administration. 7) Arrange for periodic laboratory tests of hematopoietic, renal, and hepatic systems during long-term therapy. 8) Taper dosage gradually after repeated use, especially in epileptic patients. When changing from one antiepileptic

Phenobarbito ne is a shortacting barbiturate. It depresses the sensory Availability: cortex, PEDIATRIC reduces motor PATIENTS activity, Oral Sedation: changes 2 mg/kg/dose cerebellar PO tid. 832 function, and mg/dose. produces Hypnotic: drowsiness, Determine sedation and dosage using hypnosis. Its age and weight anticonvulsan charts. t property is Antiepileptic: 3 exhibited at 6 mg/kg/day. high doses. IM or IV Status epilepticus: 15 20 mg/kg IV over 1015 min. .

Emergency control of Pregnancy certain acute seizures (eg, those associated with status epilepticus, eclampsia, meningitis, tetanus, and toxic reactions to strychnine or local anesthetics) Treatment of generalized

SOURCE:

NDH 26th edition, pg 427-429

tonic-clonic and cortical focal seizures Emergency control of acute seizures (tetanus, eclampsia, epilepticus)

Others: Pain at inj site, thrombophlebitis (IV); oliguria: laryngospasm, respiratory depression, apnoea (especially with rapid IV admin), hypoventilation. Potentially Fatal: Stevens-Johnson syndrome.

drug to another, taper dosage of the drug being discontinued while increasing the dosage of the replacement drug

Name of

Classification

Mechanism of

Indication

Contraindicati

Adverse Effects

Nursing Responsibilities

Drug Generic: Chlorampheni col Sodium Succinate Brand name: Choromycetin Sodium Succinate Pentamycetin

& Dosage Antiinfectives Availability: Adults: 50-100 mg/kg IV daily Full term infants older than age 2 wks: 50 mg/kg IV daily q6h, may use up to 100 mg/kg/day

Action Inhibits bacterial protein synthesis by binding to the 50S subunit of the ribosome; bacteriostatic. An older antibiotic, prevents bacterial cell division susceptible bacteria,. Because of potential toxic effects of this drug, its use its limited to serious infectious for which no other antibiotic is effective. Haemophilus influenza, meningitis, acute Salmonella typhi infection, and meningitis, bacteremia or severe infections caused by Salmonella species, rickettsia, lymhpho granuloma, psittacosis, or various sensitive gram negative organisms Cystic Fibrosis regimen

on Contraindicated in patients hypersensitivity to drug. Use cautiously in patients w/ impaired hepatic or renal function, acute intermittent porphyria, and G6PD deficiency. Use cautiously in those taking other drugs that cause bone barrow suppression or blood disorders. Use cautiously in premature infants & newborns because potentially fatal gray syndrome may occur. CNS: headache, mid depression, confusion, peripheral neuropathy w/ prolonged therapy EENT: optic neuritis in patients w. cystic fibrosis, decreases visual acuity GI: nausea, vomiting, stomatitis, diarrhea, glossitis Hematologic: aplastic anemia, hypoplastic anemia, granulocytopenia, thrombocytopenia Hepatic: jaundice Other: hypersensitivity reactions, anaphylaxis, gray syndrome in neonates 1) Assess patients history: hypersensitivity to benzodiazepines before giving first dose, 2) Monitor CBC, iron level, platelet & reticulocyte counts before & every 2 days during therapy. 3) Instruct patient to notify prescriber if adverse reactions occur, especially nausea, vomiting, diarrhea, fever, confusion, sore throat or mouth sores. 4) Tell patient receiving drug IV to report discomfort at IV insertion site. 5) Stop drug & notify prescriber immediately if anemia, reticulocytopenia, leukopenia, thrombocytopenia develops, 6) Monitor & instruct patient to report for signs & symptoms of superinfection.

SOURCE: NDH 26th edition, pg 2210-2111

Name of Drug Generic: Diazepam Brand name: Antenext Diazepam Diastat Ducene Valium Vivolt

Classification & Dosage Benzodiazepi ne,Anxiolytic Antiepileptic Skeletal muscle relaxant (centrally acting) Availability: Capsule 15 mg Tablets: 2mg, 5mg, 10mg Pedia: Status epilepticus (> 1 mo< 5 yr): 0.20.5 mg slowly IV q 25 min up to a maximum of 5 mg. Status epilepticus (> 5 yr): 1 mg IV q 25 min up to a maximum

Mechanism of Action A benzodiazepein e that probably potentiates the effects of GABA, depresses the CNS, and suppresses the spread of seizure activity.

Indication Acute alcohol withdrawal Anxiety Before endoscopic procedure Muscle spasm Cardioversion Adjunct treatment for seizure disorder Status epilepticus, severe recurrent seizures

Contraindicati on Contraindicated in patients hypersensitivity to drug or soy protein; in patients experiencing shock, coma, acute alcohol intoxication, in pregnant women especially first trimester, in children younger than age 6 months

Adverse Effects

Nursing Responsibilities 1) Assess patients history: Hypersensitivity to benzodiazepines 2) Change from IV therapy to oral therapy as soon as possible. 3) When using oral concentrate solution, dilute dose, just before giving. 4) Monitor periodic hepatic, renal, hematopoietic function studies In patients receiving repeated or prolonged therapy. 5) Warn patient to avoid activities that require alertness & good coordination until effects of drug are known. 6) Tell patients SO to keep patient safe. 7) Warn not to abruptly stop drug because withdrawal symptoms may occur. 8) Instruct patient to take the drug exactly as prescribed.

SOURCE: NDH 26th edition, pg

CNS: drowsiness, dysarthria, slurred speech, tremor, transient amnesia, fatigue, ataxia, headache, insomnia, paradoxical anxiety, hallucination, minor changes in EEG patients CV: hypertension, CV collapse, bradycardia EENT: diplopia , blurred vision, nystagmus Distal rectal gel GI: nausea, is constipation, contraindicated diarrhea with rectal in patients with form acute angle Hematologic: closure neutropenia glaucoma Hepatic: jaundice Respiratory: Use cautiously respiratory in patients with depression, apnea liver Skin: rash, Or renal Other: altered impairment, libido,

471-472

of 10 mg; repeat in 24 hr if necessary.

depression, chronic open angle glaucoma.

physical/psychologi cal depression, pain, phlebitis at injection site

Name of Drug Generic: Benzathine bensylpenicill in Brand: Permapen Bicillin

Classification & Dosage Anti-infective Availability: Injection: 600,000 units/ml: 1,200,000 units/2ml 2,400,000 units/4ml

Mechanism of Action

Indication Congenital syphilis Group A streptococcal upper respiratory tract infection To prevent post streptococcal rheumatic fever Syphilis of less than 1 year duration Syphilis of more than 1 yr duration

Contraindicati on Contraindicated in patients hypersensitivity to drug or other penicillin

Adverse Effects

Nursing Responsibilities 1) Before giving drug, ask patient about allergic reactions to penicillin. 2) Obtain specimen for culture and sensitivity tests before giving first dose. 3) Give drug at least 1 hour before bacteriostatic antibiotic. 4) Tell patient to report adverse reactions promptly. 5) Inform patient that fever and increased wbc count are the most common reactions. 6) Warn patient that IM injection may be painful, but that ice applied to the site may ease discomfort.

Inhibits cell wall synthesis during bacterial multiplication .

SOURCE: NDH 26th edition, 84-85

CNS: neuropathy seizures, hallucinations, confusion, fatigue, agitation, depression, Use cautiously dizziness, anxiety in patients lethargy allergic to other GI: nausea, drugs, vomiting, especially to enterocolitis, cephalosporins, pseudomembranous because of colitis possible cross- GU: interstitial sensitivity. nephritis, nephropathy Hematologic: eosinophilia, hemolytic anemia, thrombocytopenia, leukopenia, anemia, agranulocytosis Skin: maculopapular rash, exfoliative dermatitis Other: Hypersensitivity reactions, pain, sterile abscess at injection site

Name of Drug Generic: Phenytoin Sodium

Classificatio n & Dosage Anticonvulsant

Mechanism of Action A hydantoin derivative that probably stabilizes neuronal membranes and limits seizure activity by either increasing efflux or decreasing influx of Sodium ions across cell membranes in the motor cortex during generations of nerve impulses.

Indication To control tonic-clonic (grand mal) & complex partial seizures For patient requiring loading dose To prevent seizures and treat seizures occurring during neurosurgery Status epilepticus

Contraindication Contraindicated in patients hypersensitivity to hydantoin and in those with sinus bradycardia, SA block, second-third degree AV block, or Adam strokes syndrome Use cautiously inpatients with hepatic dysfunction, hypotension myocardial insufficiency, diabetes, or respiratory depression, in elderly or debilitated patients, those receiving other hydantouin derivatives

Adverse Effects CNS: ataxia, slurred speech, dizziness, insomnia, twitching, headache, mental confusion, decreased coordination CV: periarteritis nodosa EENT: nystagmus, diplopia, blurred vision GI: gingival hyperplasia, nauswea, vomiting, constipation Hematologic: thrombocytopenia, leukopenia, agranulocytosis, pancytopenia, megaloblastic anemia, macrocythemia, megaloblastoc anemia Hepatic: toxic hepatitis

Nursing Responsibilities 1) Dont give IM unless dodage adjustments are made, drug may precipitate in injection site, cause pain. 2) Divided doses given with or after meals may decrease adverse GI reactions. 3) Monitor drug level in blood, therapeutic levels is to 10-20 mcg/ml. 4) If using to treat seizures, take appropriate safety precautions, 5) Mononucleosis may decrease phenytoin level. Watch for increased seizures. 6) Watch for gingival hyperplasia, especially in children. 7) Dont; stop drug suddenly because this may worsen seizures. 8) Tell patient to notify prescriber if skin rash develops. 9) Stress to patient the importance of oral hygiene and regular dental examinations. 10) Caution patient that drug

Brand Name: Dilantin Availability: Oral suspension: 125mg/5ml Tablets: 50mg Capsule: 100 mg

SOURCE: NDH 26th edition, pge 429-430

Metabolic: hyoperglycemia Musculoskletal: osteomalacia Skin: scarlantinifomr or morbiliform rash, pupuric dermatitis, exfoliative dermatitis

may color urine, pink, red, or reddish brown.

Rose Lea Quiamco

Name of Drug Generic: Ampicillin sodium Brand Name: Ampisan

Classificatio n & Dosage Antiinfective

Mechanism of Action

Indication

Contraindication

Adverse Effects CNS: lethargy, hallucinations, anxiety,confusion, agitation, depression, fatigue,dizziness, seizure EENT:blurred vision, itchy eyes GI: nausea, vomiting, diarrhea,abdominal pain,gastritis, stomatitis GU: hematuria, hyaline casts in urine, vaginitis, nephropathy,insterti tial nephritis RESPIRATORY: wheezing,dyspnea, hypoxia, apnea SKIN:rash,urticaria , diaphoresis

Nursing Responsibilities 1) Monitor for sings and symptoms of hypersensitivity reaction 2) Check for signs and symptoms of infection at injection site. 3) Watch for bleeding tendency and hemorrhage 4) Tell pt.toreportsignsandsymptoms of infection orotherproblems atinjection site 5) Instruct pt. To immediatelyr report signs and symptoms of hypersensitivity reaction, such as rash, fever, or chills. 6) Check IV site carefully for signs of thrombosis or drug reaction. 7) Do not give IM injections in the same site; atrophy can occur.

Destroysbacteria by inhibiting bacterialcell-wall synthesis during microbial ADULTSAN multiplication. DCHILDRE Addition of NWEIGHIN sulbactam G 40 KG. enhances drugs (88lbs.)or resistance to more.1.5 to beta-lactamase, 3g. (1 g an enzyme that ampicillin can inactivate and 0.5 g ampicillin . sulbactam to 2g ampicillin and 1 g sulbactam) I.M. or

Hypersensitivity to Used for penicillins, treating bacte cephalosporins, rial infection imipenem, or other betaIntra lactamaseinhibitor abdominal, s gynecologic, and skinstructure infections caused by susceptible betalactamaseproducing strains.

SOURCE: NDH 26th edition, pge 429-430 Rose Lea Quiamco

Name of Drug

Classification & Dosage

Mechanism of Action 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. 1. First, it binds to the beta2adrenergic receptors in the airway of the smooth muscle which then leads to the activation of the adenyl cyclase and increased levels of cyclic- 35-

Indication 1. To prevent or treat bronchospasm in patients with reversible obstructive airway disease. 2. To prevent exercise-induced bronchospasm. 3. Acute asthma 4. Symptom relief during maintenance therapy of asthma and other conditions with reversible or irreversible airways obstruction (including COPD and bronchitis). 5. Can be aerosolized with a nebulizer for

Contraindication 1. Hypersensitivity to adrenergic amines and fluorocarbons 2. Use with caution in patients with CV disorders (including coronary insufficiency and hypertension), hyperthyroidism, diabetes mellitus, and those who are unusually responsive to adrenergics 3. Use extendedrelease tablets cautiously in patients with GI narrowing.

Adverse Effects

Nursing Responsibilities

Generic: Salbutamol Bronchodilator (therapeutic); adrenergics (pharmacologi c)

1. Nervousness 1. Drug may decrease sensitivity of spirometry used for diagnosis of 2. Restlessness asthma. 3. Tremor 4. Headache 5. Insomnia 6. Chest pain 7. Palpitations 8. Angina 4. Rarely, erythema multiforme or 9. Arrhythmias Stevens-Johnson Syndrome has been linked to use of syrup in 10. children. Hypertension 5. Ventolin HFA is a newer 11. Nausea and version of the Ventolin MDI for vomiting asthma and other obstructive lung diseases. Ventolin HFA uses the 12. propellant hydrofluoroalkane as an Hyperglycemia alternative to chloroflurocarbons to propel the medication. 13. Hypokalemia 6. ALERT! Tablets and aerosol may be used together but strict 3. Syrup may e taken by children as young as age 2; it contains no alcohol or sugar. 2. When switching from regular to extended-release tablets, keep in mind that a regular 2 mg tablet every 6 hours is equivalent to an extended-release 4 mg tablet every 12 hours.

adenosine monophosphate (cAMP). 2. When cAMP increases, kinases are activated. 3. Kinases inhibit the phosphorylation of myosin and decrease intracellular calcium. 4. Decreased in intracellular calcium will result to the relaxation of the smooth muscle airways.

patients with cystic fibrosis, along with ipratropium bromide, acetylcysteine, and pulmozyme. 7. May be used as a tocolytic to relax the uterine smooth muscle to delay premature labour. 8. To treat or improve muscle paralysis in patients with a condition that causes occasional paralysis. 9. To treat high potassium levels in patients with kidney failure.

monitoring for signs and symptoms of toxicity is advised. 7. ALERT! Dont confuse albuterol with atenolol or Albutein, or Flomax with Volmax.

Name of Drug

Classificatio n & Dosage Antiinfective Aminoglycos ide Pregnancy Category: C

Mechanism of Action Semisynthetic derivative of kanamycin with broad range of antimicrobial activity that includes many strains resistant to other aminoglycosides. Pharmacologic properties are essentially the same as those of gentamicin. Appears to inhibit protein synthesis in bacterial cell and is usually bactericidal.

Indication Primarily for short-term treatment of serious infections of respiratory tract, bones, joints, skin, and soft tissue, CNS (including meningitis), peritonitis burns, recurrent urinary tract infections (UTIs). Unlabeled Uses: Intrathecal or intraventricul ar administratio n, in conjunction

Contraindication History of hypersensitivity or toxic reaction with an aminoglycoside antibiotic.

Adverse Effects CNS: Neurotoxicity: drowsiness, unsteady gait, weakness, clumsiness, paresthesias, tremors, convulsions, peripheral neuritis. Special Senses: Auditory ototoxicity, highfrequency hearing loss, complete hearing loss (occasionally permanent); tinnitus; ringing or buzzing in ears; Vestibular: dizziness, ataxia. Metabolic: Hypokalemia, hypomagnesemia. Skin: Skin rash, urticaria, pruritus, redness Urogenital:

Nursing Responsibilities BEFORE: 1) Assess Renal Function before administration. 2) Obtain specimen for culture and sensitivity tests before giving the first dose. 3) Assess for any impairment in Vestibulocochlear (Eight Cranial Nerve) function. 4) Use cautiously in patient with any pre-existing vertigo or dizziness, tinnitus.

Generic Name: Amikacin sulfate

Brand Name: Amikin Availability: "250 mg/mL, 50 mg/mL injection"

Safety during pregnancy (category C), lactation, neonates and infants, or use period exceeding 14 years old is not established.

"

with IM or IV dosage.

Oliguria, urinary frequency, hematuria, tubular necrosis, azotemia. Other: Superinfections.