Drug Study Generic Brand classification Indication name name C R C Serious E O E lower F C P respiratory T E H tract R P A infections I H L UTIs.

A I O Z N P O O N R E I N S S O D ThirdU generation I M Mode of action Third-generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal. Contraindication Contraindicated in patients hypersensitive to drug or other cephalosporins. Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other betalactam antibiotics. Usual dose 5075 mg/kg/d in 2 divided doses (max 2 g/d) Actual dose 3g OD + 50 cc D5 water IV infusion per soluset to run for for 30 min Side effects CNS Fever Headache Dizziness CV Phlebitis GI Diarrhea GU Genital pruritus Candidiasis OTHERS Anaphylaxis Nsg. responsibilities Observe 10R Determine history of hypersensitivity reactions to cephalosporins and penicillins and history of other allergies, particularly to drugs, before therapy is initiated. Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy. Dosage may be started pending test results. Periodic coagulation studies (PT and INR) should be done. Inspect injection sites for induration and inflammation. Rotate sites. Note IV injection sites for signs of phlebitis (redness, swelling, pain). Monitor for manifestations of hypersensitivity . Report their appearance promptly and discontinue drug. Watch for and report signs: petechiae, ecchymotic areas, epistaxis, or any unexplained bleeding. Ceftriaxone appears to alter vitamin K-producing gut bacteria; therefore, hypoprothrombinemic bleeding may occur. Check for fever if diarrhea occurs: Report both promptly. Report any signs of bleeding. Report loose stools or diarrhea promptly.

Generic Brand classification Indication name name C B Macrolide Mild-toL I antimoderate A A infectives communityR X acquired I I pneumonia, T N caused by H H.influenzae, h. R parainfluenzae, O m.catarrhalis, S. M pneumonia, C. Y pneumonia, or C M. pnuemoniae. I N

Mode of action Inhibits protein synthesis in susceptible bacteria, causing cell death

Contraindication Contraindicated in patients hypersensitive to clarithromycin, erythromycin, or other macrolides and those receiving pimozide or other drugs that prolong QT interval or cause cardiac arrhythmias. Use cautiously in patients with hepatic or renal impairment.

Usual Actual dose dose 15 125/5mg mg/kg/day 10ml 2x PO a day for divided 1 week every 12 hours for 10 days

Side effects CNS Headache GI Diarrhea Nausea Taste perversion Abdominal pain or discomfort vomiting SKIN Rash

Nsg. responsibilities Observe 10R Tell patient to take drug as prescribed, even she feels better. Report rash or other signs of hypersensitivity immediately. Report loose stools or diarrhea even after completion of drug therapy When clarithromycin is given concurrently with anticoagulants, digoxin, or theophylline, blood levels of these drugs may be elevated. Monitor appropriate serum levels and assess for S&S of drug toxicity. Tell patient that they may feel the side effects like: fever. Rash, nausea, vomiting, fatigue,, pain at injection site Report numbness or tingling , severe headache, nausea, rash, extreme, extreme fatigue, edema, pain or swelling at injection site

Generic name D I G O X I N

Brand name L A N O X I N

classification Cardiac glycoside, cardiotonic

Indication Heart failure, paroxysmal supraventricular tachycardia, arterial fibrillation and flutter.

Mode of action inhibits sodiumpotassiumactivated adenosine triphosphatase, promoting movement of calcium from extracellular to intracellular cytoplasm and strengthening myocardial contraction. Also acts on CNS to enhance vagal tone, slowing conduction through the SA and AV nodes.

Contraindication Contraindicated in patients hypersensitive to drug and those with digitalis-induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure.

Actual dose 2.6 ml 20-35 BID mcg/kg PO

Usual dose

Side effects CNS Headache Dizziness Vertigo Stupor Paresthesia CV Arrhythmias GI Diarrhea Vomiting Nausea EENT Blurred vision Light flashes Photophobia Diplopia

Nsg. responsibilities Observe 10R Check dosage and preparation carefully. Avoid giving with meals; this will delay absorption. Do not stop taking this drug without notifying your health care provider. Weigh yourself every other day with the same clothing and at the same time. Record this on the calendar. 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. Take pulse at the same time each day, and record it on a calendar (normal pulse for you is___; call your health care provider if your pulse rate falls below ____.)

Generic name C E T I R I Z I N E H Y D R O C H L O R I D E

Brand name Z Y R T E C

classification A N T I H I S T A M I N E S

Indication Seasonal allergic rhinitis

Mode of action A long-acting nonsedating antihistamine that selectively inhibits peripheral H1 receptors.

Contraindication Contraindicated in patients hypersensitive to drug or hydroxyzine and in breastfeeding women. Use cautiously in patients with renal or hepatic impairement.

Usual dose 5 to 10 mg

Actual dose 1 tab OD at HS

Side effects CNS Fatigue Headache Dizziness EENT Pharyngitis GI Diarrhea Dry mouth Nausea Abdominal distress

Nsg. responsibilities Observe 10R Assessment History: Allergy to any antihistamines, hydroxyzine; narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction; lactation Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision exam; R, adventitious sounds; prostate palpation; renal function tests Interventions Give without regard to meals. Provide syrup form for pediatric use if needed. Arrange for use of humidifier if thickening of secretions, nasal dryness become bothersome; encourage adequate intake of fluids. Provide skin care for urticaria. Teaching points Take this drug without regard to meals. These side effects may occur: Dizziness, sedation, drowsiness (use caution if driving or performing tasks that require alertness); thickening of bronchial secretions, dryness of nasal mucosa (humidifier may help). Report difficulty breathing, hallucinations, tremors, loss of coordination, irregular heartbeat

Generic Brand classification name name Ipratropium Combivent Antiasthmatic Br, & COPD Salbutamol/ Preparations albuterol sulfate

Indication Management of reversible bronchospasm associated with obstructive airway diseases in patients who require more than a single bronchodilator

Usual Actual dose dose Beta2 adrenergic Patient with cardiac 1 neb 1 neb receptor cause tachyarrythmias, every q8 bronchodilation hypertropic 6-8 hr and vasodilation obstructive cardiomyopathy Anticholinergic, and patient with blocks reflexes by history of antagonizing action hypersensitivity of acetylcholine

Mode of action

Contraindication

Side effects

Nsg. responsibilities 1.) Use Cautiously to patients with known sensitivity to atropine, soybeans, soya lecithin, and peanuts. 2.) Assess Vital Signs Before drug administration 3.) Observe for paradoxical bronchospasm (Wheezing). If Condition occurs, withhold Medication and notify physician or other health care professional immediately. 4.) Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain. Advise the patient to rinse mouth with water after using the nebulizer to minimize dry mouth.

mild headach e; or cold sympto ms such as stuffy nose, sneezin g, cough, or sore throat.

Generic Brand classification name name Ranitidine Zantac Histamine H2 antagonists

Indication reatment and prevention of acid indigestion, and sour stomach.

Mode of action nhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.

Contraindication Hypersensitivity, Cross-sensitivity may occur;

Usual Actual Side effects dose dose 20 mg 33 mg NS: IV IVTT Confusion, q8h q8 dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis

Nsg. responsibilities Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray black.

Generic Brand name name spironol Aldact actone one

classificatio n Potassiumsparing diuretic

Indication Prevent fluid overload

Mode of action Spironolacto ne acts on the distal renal tubules as a competitive antagonist of aldosterone. It increases the excretion of sodium chloride and water while conserving potassium and hydrogen ions.

Contraindication Anuria, hyperkalemia, acute or progressive renal insufficiency. Addisons disease.

Usual Actual Side effects Nsg. responsibilities dose dose 13.3 25 mg Fluid or Assessment mg/kg/da tab BID electrolyte History: Allergy to spironolactone; hyperkalemia; y PO imbalance, renal disease; pregnancy, lactation adjusted gynecomastia, Physical: Skin color, lesions, edema; orientation, to GI upset, reflexes, muscle strength; P, baseline ECG, BP; R, patients drowsiness, pattern, adventitious sounds; liver evaluation, response, headache, bowel sounds; urinary output patterns, menstrual administe hyponatremia; cycle; CBC, serum electrolytes, renal function red as tachycardia, tests, urinalysis single or hypotension, Interventions divided oliguria, Mark calendars of edema outpatients as reminders dose hyperkalemia; of alternate day or 3- to 5-day/wk therapy. confusion, Make suspension as follows: Tablets may be weakness, pulverized and given in cherry syrup for young paresthesia, children. This suspension is stable for 1 mo if refrigerated. Measure and record regular weight to monitor mobilization of edema fluid. Avoid giving food rich in potassium. Arrange for regular evaluation of serum electrolytes and BUN. Teaching points Record alternate-day therapy on a calendar, or prepare dated envelopes. Take the drug early because of increased urination. Weigh yourself on a regular basis, at the same time and in the same clothing, and record the weight on your calendar. Avoid foods that are rich in potassium (fruits, Sanka); avoid licorice. You may experience these side effects: Increased volume and frequency of urination; dizziness, confusion, feeling faint on arising, drowsiness (avoid rapid position changes, hazardous

activities: such as driving, using alcohol); increased thirst (suck on sugarless lozenges; use frequent mouth care); changes in menstrual cycle, deepening of the voice, impotence, enlargement of the breasts can occur (reversible). Report weight change of more than 3 pounds in 1 day, swelling in your ankles or fingers, dizziness, trembling, numbness, fatigue, enlargement of breasts, deepening of voice, impotence, muscle weakness, or cramps.