DRUG STUDY

Generic Name: MECHANISM ADVERSE REACTION/SIDE NURSING RESPONSIBILITIES

EFFECTS
Azithromycin OF ACTION - Assess patient for infection (vital signs;
CNS: dizziness, seizures, drowsiness, appearance of wound, sputum, urine, and
Inhibits protein synthesis at the level of
fatigue, headache. CV: chest pain, stool; WBC) at beginning of and throughout
the 508 bacterial ribosome. Therapeutic
hypotension, palpita- tions, QT therapy.
Effects: Bacteriostatic action against
prolongation (rare). GI: PSEUDOMEM-
susceptible bacteria Spectrum: Active
against the following grampositive
Brand Name: - Obtain specimens for culture and sensitivity
aerobic bacteria: Staphylococcus aureus,
BRANOUS COLITIS, abdominal pain, before initiating therapy. First dose may be
Zithromax, Zmax Streptococcus pneumoniae, S. pyogenes
diarrhea, nau- sea, cholestatic jaundice, given before receiving results.
(group A strep). Active against these
Classification: elevated liver enzymes, dyspepsia,
gram-negative aerobic bacteria:
flatulence, melena, oral candidiasis. GU:
Therapeutic: agents for atypical Haemophilus influenzae, Morax ella
nephritis, vaginitis. Hemat: anemia, - Observe for signs and symptoms of
mycobacterium, anti-infectives. catarrhalis, Neisseria gonorrhoeae. Also
leuko- penia, thrombocytopenia. Derm: anaphylaxis (rash, pruritus, laryngeal edema,
Pharmacologic: macrolides ac tive against: Mycoplasma, Legionella,
STEVENS-JOHN-SON SYNDROME, wheezing). Notify health care professional
Chlamydia pneumoniae, Ureaplasma
TOXIC EPIDERMAL NECROLYSIS, immediately if these occur.
Dosage/Frequency/route: urealyticum, Bor- relia burgdorferi, M.
pho- tosensitivity, rashes. EENT:
avium. Not active against methicillin-
500g 1tab OD ototoxicity. F and E: hyperkalemia.
resistant S. aureus.
Misc: ANGIOEDEMA. - Assess patient for skin rash frequently
INDICATION during therapy. Discontinue azithromycin at
first sign of rash; may be life-threatening.
Treatment of the following infections due
Stevens-John- son syndrome or toxic
to sus- ceptible organisms: Upper
epidermal necrolysis may develop. Treat
respiratory tract infec- tions, including
symptomatically; may recur once treatment is
streptococcal pharyngitis, acute bacterial stopped.
exacerbations of chronic bronchitis and
tonsillitis; Lower respiratory tract
infections, including bronchitis and
pneumonia; Acute otitis media; Skin and
skin structure infections; Non-
gonococcal urethritis, cervicitis,
gonorrhea, and chancroid. Prevention of
disseminated Mycobac terium avium
complex (MAC) infection in pa- Or
chills; tients with advanced HIV
infection. Extended-re- cult uri- lease
suspension (ZMax) Acute bacterial
sinusitis and community-acquired
pneumonia in o health adults. Unlabeled
Use: Prevention of bacterial endocarditis.
Treatment of cystic fibrosis lung dis ease.

CONTRAINDICATION
Contraindicated in: Hypersensitivity to
azithro mycin, erythromycin, or other
macrolide anti-in- fectives.
Use Cautiously in: Severe liver
impairment (dose adjustment may be
required); Severe renal ct infec-
impairment (CCr <10 mL/min);
Myasthenia gravis (may worsen
symptoms); OB, Lactation: itis and Safety
not established; Pedi: Safety not
 established in children <5 yr.
Reference: Davis’s drug guide for nurses 12th edition
Generic Name: MECHANISM
Acetylcysteine OF ACTION
PO: decreases the build up of hepatotoxic
metabolite in a acetaminophen over
dosage. IV: decreases the build up of a
hepatotoxic metabolite in acetaminophen
over dosage. INHALATION: degrades
mucus, allowing easier mobilization and
expectorant. Therapeutic effects: PO:
Prevention or lessening of liver damage
following acetaminophen. Inhaln:
Brand Name:
Lowers viscosity of mucus.
Acetadote, Mucomyst, Parvolex
INDICATION
Classification: PO: Antidote for the management of
Therapeutic: antidotes (for acetaminophen potentially hepatotoxic over dosage of
toxicity), mucolytic acetaminophen. IV: antidote for the
management of conditions associated
Dosage/Frequency/route: with thick viscid mucous secretions.
600mg tab BID PO Unlabeled Use: Prevention of
radiocontrast-induced renal dysfunction
(oral).
ADVERSE REACTION/SIDE NURSING RESPONSIBILITIES
EFFECTS
Assessment
CNS: drowsiness. - Antidote in Acetaminophen Overdose: Assess
type, amount, and time of acetaminophen
CV: vasodilation.
ingestion.
EENT: rhi- norrhea.
- Assess plasma acetaminophen levels. Initial
Resp: bronchospasm, bronchial/tra- cheal levels are drawn at least 4 hr after ingestion of
irritation, chest tightness, increased secre- acetaminophen.
ophen tions.
- Plasma level determinations may be difficult
GI: nausea, vomiting, stomatitis. to interpret following ingestion of extended-
release preparations.
Derm: rash, clamminess, pruritus,
urticaria. Misc: aller- gic reactions - Do not wait for results to administer dose.
(primarily with IV), including
IV: Assess for anaphylactoid reaction.
Erythema and flushing are common, usually
occurring 30-60 min after initiating infusion,
and may resolve with continued administration.
If rash, hypotension, wheezing, dyspnea occur,
initiate treatment for anaphylaxis
(antihistamine and epinephrine).
Acetylcysteine infusion should be interrupted
until symptoms resolve and care- fully
restarted. If anaphylactoid reaction re- curs,
 CONTRAINDICATION
Contraindicated in: Hypersensitivity.
Use Cautiously in: Severe respiratory
insuffi ciency, asthma, or history of
bronchospasm; His tory of GI bleeding
(oral only); OB, Lactation: Safety not
established.
Reference: Davis’s drug guide for nurses 12th edition
discontinue acetylcysteine and use alter- native
form of treatment.
• Monitor AST, ALT, and bilirubin levels
along with prothrombin time every 24 hr for 96
hr in patients with plasma acetaminophen
levels in- dicating potential hepatotoxicity.
• Monitor cardiac and renal function (creati-
nine, BUN), serum glucose, and electrolytes.
Maintain fluid and electrolyte balance, correct
hypoglycemia, and administer vitamin K or
fresh frozen plasma or clotting factor concen-
trate if prothrombin time ratio exceeds 1.5 or 3,
respectively.
- Assess patient for nausea, vomiting, and urti-
caria. Notify health care professional if these
occur.
Generic Name: MECHANISM
Ceftazidime OF ACTION
Bind to the bacterial cell wall membrane,
causing cell death. Therapeutic Effects:
Bactericidal ac- tion against susceptible
bacteria. Spectrum: Sim- ilar to that of
second-generation cephalosporins, but
activity against staphylococci is less,
whereas activity against gram-negative
pathogens is greater, even for organisms
resistant to first- and second-generation
agents. Notable is increased action
Brand Name:
against: Enterobacter, Haemophilus in-
Fortaz, tazicef fluenzae, Escherichia coli, Klebsiella
pneumo- niae, Neisseria gonorrhoeae,
Classification:
Citrobacter, Mor- ganella, Proteus,
Therapeutic: anti-infectives Providencia, Serratia, Moraxella
Pharmacologic: third-generation cephalo- catarrhalis, Borrelia burgdorferi. Some
sporins agents have activity against N.
meningitidis (cefotaxime, ceftazidime,
Pregnancy Category B
ceftizoxime, ceftriax- one). Some agents
Dosage/Frequency/route: have enhanced activity against
Pseudomonas aeruginosa (ceftazidime,
2g q8° IV
cefoper- azone). Not active against
methicillin-resistance staphylococci or
enterococci. Some agents have activity
against anaerobes, including Bacteroides
fragilis (cefoperazone, cefotaxime,
ADVERSE REACTION/SIDE NURSING RESPONSIBILITIES
EFFECTS
- Assess for infection (vital signs; appearance
NS: SEIZURES (high doses), of wound, sputum, urine, and stool; WBC) at
headache. be- ginning of and throughout therapy. •
Before initiating therapy, obtain a history to
GI: PSEU- DOMEMBRANOUS
determine previous use of and reactions to
COLITIS, diarrhea, nausea, vomit-
penicillins or cephalosporins. Persons with a
ing, cholelithiasis (ceftriaxone),
negative history of penicillin sensitivity may
cramps.
still have an allergic response.
Derm: STEVENS-JOHNSON
SYNDROME, rashes, urticaria.
Hemat: agranulocytosis, bleeding (↑
- Obtain specimens for culture and sensitivity
with cefo- perazone), eosinophilia,
be- fore initiating therapy. First dose may be
hemolytic anemia, lym- phocytosis,
given before receiving results.
neutropenia, thrombocytopenia,
thrombocytosis.
GU: hematuria, vaginal moniliasis. - Observe for signs and symptoms of
Local: pain at IM site, phlebitis at IV anaphylaxis (rash, pruritus, laryngeal edema,
site. wheezing). Discontinue drug and notify health
Misc: allergic reactions including care profes- sional immediately if these
ANAPHYLAXIS and SERUM symptoms occur. Keep epinephrine, an
SICKNESS, super infection. antihistamine, and resus- citation equipment
close by in the event of an anaphylactic
reaction.
- Monitor bowel function. Diarrhea, abdominal
cramping, fever, and bloody stools should be
reported to health care professional promptly
as a sign of pseudomembranous colitis. May
ceftizoxime, ceftriaxone). begin up to several weeks following cessation
of therapy.

INDICATION
Treatment of the following infections
caused by susceptible organisms: Skin
and skin structure in- fections (not
cefixime), Urinary and gynecologic
infections (not cefdinir, cefditoren, or
ceftibu- ten), Respiratory tract infections
(not cefdinir, cefditoren, or ceftibuten).
Cefotaxime, ceftazi- dime, ceftizoxime,
ceftriaxone: Meningitis and bone/joint
infections. Cefoperazone, cefo- taxime,
ceftazidime, ceftizoxime, ceftriax- cially
one: Intra-abdominal infections and
septicemia. Cefdinir, cefixime,
cefpodoxime, ceftibuten, lting
ceftriaxone: Otitis media. Cefotaxime,
cef- triaxone: Perioperative prophylaxis.
Ceftazi- dime: Febrile neutropenia.
Cefotaxime, cef- triaxone: Lyme disease.

CONTRAINDICATION
Contraindicated in: Hypersensitivity to
cephalosporins; Serious hypersensitivity
to penicillins; Pedi: Hyperbilirubinemic
neonates (ceftriaxone only; may lead to
kernicterus); Pedi: Neonates $28 days
 requiring calcium-containing IV solu-
tions (↑ risk of precipitation formation);
Carni- tine deficiency or inborn errors of
metabolism (cefditoren only);
Hypersensitivity to milk protein
(ceftidoren only; contains sodium
caseinate). Use Cautiously in: Renal
impairment (dos- ing/ dosing interval
recommended.

Reference: Davis’s drug guide for nurses 12th edition

 FOCUS OF ASSESSMENT

A thorough history and physical examination should be obtained/performed in patients presenting with CHF to identify cardiac and noncardiac disorders
or behaviors that might cause or accelerate the development or progression of HF. Volume status and vital signs should be assessed at each patient
encounter. This includes serial assessment of weight and the presence of peripheral edema or orthopnea.

 Inspect: Face, lips, and ears for cyanosis Chest for deformities, scars, visible pulsations Bilateral arms/hands, noting color, warmth, movement,
sensation (CWMS), edema, color of nail beds, nail shape, and capillary refill Bilateral legs, noting CWMS, hair distribution, edema to lower legs
and feet, color of nail beds, and capillary refill, numbness/tingling calf size/pain for signs of deep venous thrombosis (DVT)
 Auscultate: Aortic/Pulmonic/Erb’s point/Tricuspid/Mitral Auscultate apical pulse for one minute. Note the rate and rhythm and heart sounds
 Palpate: Inspect and palpate of the heart Bilateral radial, brachial, dorsalis pedis, and posterior tibialis pulses, skin turgor and edema

Tests that may be done to diagnose congestive heart failure may include:

Electrocardiogram (ECG or EKG): This quick and painless test records the electrical signals in the heart. It can show how fast or how slowly the heart
is beating. Chest x-ray: May show enlarged cardiac shadow, reflecting chamber dilation/hypertrophy, or changes in blood vessels, reflecting increased
pulmonary pressure.

Echocardiogram: Sound waves create images of the beating heart. This test shows the size and structure of the heart and heart valves and blood flow
through the heart.

CT scan of the heart: Also called a cardiac CT scan, this test uses X-rays to create cross-sectional images of the heart.
Heart MRI scan: also called a cardiac MRI. This test uses magnetic fields and radio waves to create detailed images of the heart.

Pulse oximetry: Oxygen saturation may be low, especially when acute HF is imposed on chronic obstructive pulmonary disease (COPD) or chronic HF.

Complete blood count (CBC): May reveal anemia, polycythemia, or dilutional changes indicating water retention. Levels of white blood cells (WBCs)
may be elevated, reflecting recent/acute MI, pericarditis, or other inflammatory or infectious states.

Blood tests: Blood tests can help diagnose diseases that can affect the heart. Blood tests also can look for a specific protein made by the heart and blood
vessels. In heart failure, the level of this protein goes up.