Medications Generic name: PiperacillinTazobactam Drug classification: >Antibiotic >BetaLactamase Inhibitor

Therapeutic Actions
Piperacillin: Binds to bacterial cell wall membrane, causing cell death. Spectrum is extended compared with other penicillins Tazobactam: Inhibits betalactamase, an enzyme that can destroy penicillins >Death of susceptible bacteria

Indications
>piperacillin/tazobactam consists of a semisynthetic 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

Contraindications
>Hypersensitivity to penicillins, betalactams, cephalosporins, or tazobactam (crosssensitivity may occur)

Adverse effects
CNS: SEIZURES (HIGHER DOSES) , confusion, dizziness, headache, insomnia, lethargy. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, constipation, drug-induced hepatitis, nausea, vomiting. GU: interstitial nephritis. Derm: rashes ( in cystic fibrosis patients), urticaria. Hemat: bleeding, leukopenia, neutropenia, thrombocytopenia. Local: pain, phlebitis at IV site. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS AND SERUM SICKNESS , fever ( in cystic fibrosis patients), superinfection. *CAPITALS indicates lifethreatening. *italic indicates most frequent.

Nursing Responsibilities
>Monitor patient carefully during the first 30 min after initiation of the infusion for signs of hypersensitivity

>Lab tests: C&S prior to first dose of the drug; start drug pending results. Monitor hematologic status with prolonged therapy (Hct and Hgb, CBC with differential and platelet count)

>Obtain history of hypersensitivity to penicillins, cephalosporins, or other drugs prior to administration.

Medications Generic name: Lanoxin Drug classification:

Antiarrhythmics Dosage: .25mg .5tab OD 6am

Therapeutic Actions
>Increases intracellular calcium and allows more calcium to enter the myocardial cell during depolarization via a sodium-potassium pump mechanism; this increases force of contraction (positive inotropic effect), increases renal perfusion (seen as deuretict effect in patients with heart failure), decreases heart rate (negative chronotropic effect), and decreases AV node conduction velocity.

Indications
Heart Failure Atrial Fibrillation

Contraindications
Contraindicated with allergy to cardiac glycosides, ventricular tachycardia, ventricular fibrillation, heart block, sick sinus syndrome, IHSS, acute MI, renal insufficiency and electrolyte abnormalities with pregnancy and lactation.

Adverse effects
CNS: Headace, weakness, drowsiness, visual disturbances, mental status change CV: Arrhythmias GI: GI upset, anorexia

Nursing Responsibilities
>Monitor apical pulse for 1 minute before administering; hold dose if pulse lower than 60 beats/min in adult or lower than 90 beats/min in infant. >Note any change from baseline rhythm or rate. - Check dosage and preparation and carefully. -Avoid IM injections, which may be very painful. - Avoid giving with meals; taking this drug with food will delay absorption and alter drug pharmacokinetics.

Medications Generic name: Lasix Drug classification: >ELECTROLYTIC AND WATER BALANCE AGENT >LOOP DIURETIC Dosage: 20mg (IV) OD 8am

Therapeutic Actions
>Rapid-acting potent sulfonamide loop diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly defined; decreases renal vascular resistance and may increase renal blood flow.

Indications
>Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis.

Contraindications
>Furosemide is contraindicated in patients with anuria or who are hypersensitive to the drug. The manufacturer states that the drug should be discontinued in patients with progressive renal disease if increasing azotemia and oliguria occur during therapy. >Furosemide should be used with caution in patients with preexisting electrolyte or water balance abnormalities, impaired hepatic function (may precipitate hepatic coma) and diabetes mellitus. Patients with conditions that may lead to electrolyte or water balance abnormalities (e.g., vomiting, diarrhea, etc.) should be monitored carefully. Patients hypersensitive to sulfonamides may also be hypersensitive

Adverse effects
>Headaches,

Nursing Responsibilities

Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. Monitor BP during periods of diuresis and through period of dosage adjustment. Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician. Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter.

anemia, and vertigo are some of furosemide's possible side effects. Problems with this drug are generally minor  and can usually be treated by you or your healthcare provider. However,  if you experience any serious side effects, such as unexplained swelling, a rash, or ringing in the ears, contact your healthcare provider immediately.

Monitor for S&S of hypokalemia (see Appendix F).

Monitor I&O ratio and pattern. Report

to furosemide (not documented in veterinary species).

decrease or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions.

Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia.

Note: Excessive dehydration is most likely to occur in older adults, those with chronic cardiac disease on prolonged salt restriction, or those receiving sympatholytic agents.

Medications Generic name: Coralan Drug classification:

Antianginal

Therapeutic Actions
Stable angina typically occurs when you exert yourself, and is usually relieved with medication or rest. Angina is a pain or uncomfortable feeling in the chest. This pain or feeling can also spread to the arms and neck and sometimes also to the shoulders and back. Angina is caused by too little blood and oxygen getting to the heart.

Indications
Treatment of coronary artery disease: Symptomatic treatment of chronic stable angina pectoris in CAD (coronary artery disease) patients with normal sinus rhythm. Indicated in patients unable to tolerate or with a contraindication to the use of beta-blockers, or in combination with betablockers in patients inadequately controlled with an optimal beta-blocker dose and whose heart rate is >60 bpm. Treatment of chronic heart failure: Reduction of cardiovascular events (cardiovascular mortality or hospitalization for worsening heart failure) in adults in sinus rhythm with symptomatic chronic heart failure & with heart rate >/=70 bpm.

Contraindications
Children <18 yr. Resting heart rate <60 beats/min prior to treatment, cardiogenic shock, acute MI, severe hypotension (<90/50 mmHg), severe hepatic insufficiency, sick sinus syndrome, SA block, unstable angina, severe heart failure, pacemakerdependent patient, 3rd degree AV-block. Concomitant potent CYP3A4 inhibitors. Pregnancy & lactation.

Adverse effects
May cause temporary luminous visual phenomena (phosphenes), which may impair ability to drive or operate machinery, blurred vision, bradycardia, 1st degree AV block, ventricular extrasystoles, headache, and dizziness.

Nursing Responsibilities

Dosage: 7.5mg 1tab OD 8am

Medications Generic name: Actrapid Drug classification:

Therapeutic Actions

Indications
Actrapid Insulin is used as insulin replacement for people who are suffering from diabetes

Contraindications Hypoglycaemia

Adverse effects
Actrapid Insulin has known side effects, which may include:

Nursing Responsibilities -monitor first the blood sugar concentration -check for the prescription of doctor -when administering the insulin, do not inject it to the same site where previous injection were given

Insulin binds to receptor protein on cell surface > second messenger > initiate transport effects & anabolic effects

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Allergic reaction to active ingredient Low blood glucose levels or hyperglycemia Skin thickening or pitting when injection is given too frequently at the same site Redness, thickening or swelling at the injection site

Other side effects may also occur. Side effects may vary from personto-person. Inform your doctor immediately if you experience these symptoms or if you experience anything unusual in your body after taking this drug.

Medications Generic name: Irbesartan (Aprovel) Drug classification: Antihypertensive Dosage: 150mg .25tab OD, 9pm

Therapeutic Actions
>Selectively blocks the binding of angiotensin II to specific tissue receptors found in the vascular smooth muscle and adrenal gland; this action blocks the vasoconstriction effect of the rennin-angiotensin system as well as the release of aldosterone, leading to decreased BP.

Indications
Treatment of hypertension as monotherapy or in combination with other antihypertensives Slowing of the progression of nephropathy in patients with hypertension and type 2 diabetes.

Contraindications
Contraindicated with hypersensitivity to irbesartan, pregnancy Use cautiously with hepatic or renal impairment, hypovolemia, volume or sodium depletion, lactation, pregnancy.

Adverse effects
CNS: Headache, dizziness, syncope, muscle weakness, sleep disturbance CV: Hypotension, orthostatic hypotension, flushing GI: Diarrhea, abdominal pain, nausea, constipation, dry mouth, dental pain RESPIRATORY: cough, sinus disorders

Nursing Responsibilities
>Alert surgeon and mark the patient s chart with notice that irbesartan is being taken. The blockage of the renin-angiotensin system following surgery can produce problems. Hypotension may be reversed with volume expansion. - Monitor patient so closely in any situation that may lead to a decrease in BP secondary to reduction in fluid volume; excessive hypotension can occur.

Medications Generic name: Aldactone (spironolactone) Drug classification: Aldosterone antagonist Dosage: 75mg OD

Therapeutic Actions
>Competitively blocks the effects of aldosterone in the renal tubule, causing loss of sodium and water and retention of potassium.

Indications
Diagnosis and maintenance of primary hyperaldosteronism. Treatment of hypokalemia or prevention of hypokalemia in patients who would be at high risk if hypokalemia occurred, patients with cardiac arrhythmias.

Contraindications
Contraindicated with allergy to spironolactone , hyperkalemia, renal disease, anuria. Use cautiously with pregnancy, lactation

Adverse effects
CNS: Headache, dizziness, drowsiness, fatigue, ataxia, confusion DERMATOLOGIC: Rash, urticaria GI: cramping, diarrhea, dry mouth, thirst, vomiting GU: amenorrhea, irregular menses, postmenopausal bleeding HEMATOLOGIC: hyperkalemia, hyponatremia, agranulocytosis

Nursing Responsibilities
>Give daily doses early so that increased urination does not interfere with sleep. >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.