Amoxicillin

CLASSIFICATION
PHARMACOTHERAPEUTIC: Penicillin.
CLINICAL: Antibiotic.

SIDE EFFECTS
Frequent: GI disturbances (mild diar
rhea, nausea, vomiting), headache, oral/
vaginal candidiasis.
Occasional: Gener
alized rash, urticaria.
ADVERSE EFFECTS/
TOXIC REACTIONS
Antibiotic-associated colitis, other super
infections (abdominal cramps, severe
watery diarrhea, fever) may result from
altered bacterial balance in GI tract. Se
vere hypersensitivity reactions, including
anaphylaxis, acute interstitial nephritis,
occur rarely.

NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Question for history of allergies (esp.
penicillins, cephalosporins), renal im

pairment.
INTERVENTION/EVALUATION
Promptly report rash, diarrhea (fever,
abdominal pain, mucus and blood in
stool may indicate antibiotic-associated
colitis). Be alert for superinfection: fever,
vomiting, diarrhea, anal/genital pruri
tus, black “hairy” tongue, oral mucosal
changes (ulceration, pain, erythema).
Monitor renal/hepatic function tests.
PATIENT/FAMILY TEACHING
• Continue antibiotic for full length
of treatment.
• Space doses evenly.
• Take with meals if GI upset oc

curs. • Thoroughly crush or chew the

chewable tablets before swallow
ing. • Report rash, diarrhea, other new
symptoms.

ciprofloxacin

CLASSIFICATION
PHARMACOTHERAPEUTIC: Fluoro
quinolone. CLINICAL: Antibiotic.

SIDE EFFECTS
Frequent (5%–2%): Nausea, diarrhea,
dyspepsia, vomiting, constipation, flatu
lence, confusion, crystalluria. Ophthal
mic: Burning, crusting in corner of eye.
Occasional (less than 2%): Abdominal
pain/discomfort, headache, rash. Oph
thalmic: Altered taste, sensation of for
eign body in eye, eyelid redness, itching.
Rare (less than 1%): Dizziness, confusion,
tremors, hallucinations, hypersensitivity re
action, insomnia, dry mouth, paresthesia.
ADVERSE EFFECTS/TOXIC
REACTIONS
Superinfection (esp. enterococcal, fun
gal), nephropathy, cardiopulmonary
arrest, cerebral thrombosis may occur.
Hypersensitivity reaction (rash, pruritus,
blisters, edema, burning skin), photo
sensitivity have occurred. Sensitization
to ophthalmic form may contraindicate
later systemic use of ciprofloxacin. May
exacerbate muscle weakness in pts with
myasthenia gravis. Dermatologic condi
tions such as toxic epidermal necrolysis,
Stevens-Johnson syndrome have been
reported. Cases of severe hepatotoxicity
have occurred. May increase risk of ten
donitis, tendon rupture.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Question for history of hypersensitivity
to ciprofloxacin, quinolones; myasthenia
gravis, renal/hepatic impairment.
INTERVENTION/EVALUATION
Obtain urinalysis for microscopic analy
sis for crystalluria prior to and dur
ing treatment. Evaluate food tolerance.
Monitor daily pattern of bowel activity,
stool consistency. Encourage hydration
(reduces risk of crystalluria). Monitor
for dizziness, headache, visual changes,
tremors. Assess for chest, joint pain.
Ophthalmic: Observe therapeutic re
sponse.

PATIENT/FAMILY TEACHING
• Do not skip doses; take full course of
therapy. • Maintain adequate hydration
to prevent crystalluria.
• Do not take
antacids within 2 hrs of ciprofloxacin
(reduces/destroys effectiveness). •
Shake suspension well before using; do
not chew microcapsules in suspen

sion. • Sugarless gum, hard candy may

relieve bad taste.
• Avoid caffeine.
•
Report tendon pain or swelling.
• Avoid
exposure to sunlight/artificial light (may
cause photosensitivity reaction). • Re
port persistent diarrhea.

Brand name: Neopred

predniSONE

CLASSIFICATION
PHARMACOTHERAPEUTIC: Adrenal
corticosteroid. CLINICAL: Anti-in
flammatory, immunosuppressant.

SIDE EFFECTS
Frequent: Insomnia, heartburn, nervous
ness, abdominal distention, diaphoresis,
acne, mood swings, increased appetite,
facial flushing, delayed wound healing,
increased susceptibility to infection, di
arrhea, constipation. Occasional: Head
ache, edema, change in skin color,
frequent urination. Rare: Tachycardia,
allergic reaction (rash, urticaria), psy
chological changes, hallucinations, de
pression.
ADVERSE EFFECTS/TOXIC
REACTIONS
Long-term therapy: Muscle wasting
(esp. in arms, legs), osteoporosis, spon
taneous fractures, amenorrhea, cataracts,
glaucoma, peptic ulcer, HF. Abrupt with
drawal following long-term therapy:
Anorexia, nausea, fever, headache, re

bound inflammation, fatigue, weakness,

lethargy, dizziness, orthostatic hypoten

sion. Sudden discontinuance may be fatal.

NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Question medical history as listed in
Precautions. Obtain baselines for height,
weight, B/P, serum glucose, electrolytes.
Check results of initial tests (tuberculosis
[TB] skin test, X-rays, ECG).
INTERVENTION/EVALUATION
Monitor B/P, serum electrolytes, glu
cose, results of bone mineral density
test, height, weight in children. Be alert
to infection (sore throat, fever, vague
symptoms); assess oral cavity daily for
signs of Candida infection. Monitor for
symptoms of adrenal insufficiency, im
munosuppression.
PATIENT/FAMILY TEACHING
• Report fever, sore throat, muscle aches,
sudden weight gain, swelling, loss of ap

petite, or fatigue.
• Avoid alcohol, mini

mize use of caffeine. • Report symptoms

of elevated blood sugar levels (blurred vi
sion, headache, increased thirst, frequent
urination). • Maintain strict oral hy
giene. • Do not abruptly discontinue
without physician’s approval. • Avoid
exposure to chickenpox, mea
sles. • Long-term use may significantly
increase risk of serious infections.

BRAND NAME: TGP

finasteride

CLASSIFICATION
PHARMACOTHERAPEUTIC: 5-alpha
reductase inhibitor. CLINICAL:
Be
nign prostatic hyperplasia agent.

SIDE EFFECTS
Rare (4%–2%): Gynecomastia, sexual
dysfunction (impotence, decreased
libido, decreased volume of ejaculate).
ADVERSE EFFECTS/TOXIC
REACTIONS
Hypersensitivity reaction, circumoral
swelling, testicular pain occur rarely
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Digital rectal exam, serum prostate-specific
antigen (PSA) determination should be per
formed in pts with benign prostatic hyper
plasia (BPH) before initiating therapy and
periodically thereafter. Assess usual urinary
characteristics (frequency, ability to empty
bladder, urinary flow). Assess degree of uri
nary retention with baseline bladder scan.
INTERVENTION/EVALUATION
Diligently monitor I&O, esp. in pts with
large residual urinary volume, severely
diminished urinary flow, or obstructive
uropathy. Obtain periodic bladder scan
to assess treatment effectiveness (or to
assess for acute urinary retention).
PATIENT/FAMILY TEACHING
• Treatment may cause impotence, de
creased volume of ejaculate. • May not
notice improved urinary flow even if
prostate gland shrinks. • Must take
medication longer than 6 mos, and it is
unknown if medication decreases need
for surgery. • Because of potential risk
to male fetus, women who are or may
become pregnant should not handle tab
lets or be exposed to pt’s semen. • Im
mediately report inability to urinate or
severe bladder pain.

Brand name: tergecef

cefixime
uCLASSIFICATION
PHARMACOTHERAPEUTIC: Third
generation cephalosporin.
CLINI
CAL: Antibiotic.

SIDE EFFECTS
Frequent: Oral candidiasis (thrush),
mild diarrhea, mild abdominal cramping,
vaginal candidiasis. Occasional: Nausea,
serum sickness–like reaction (arthral
gia, fever; usually occurs after second
course of therapy and resolves after drug
is discontinued). Rare: Allergic reaction
(rash, pruritus, urticaria).
ADVERSE EFFECTS/TOXIC
REACTIONS
Antibiotic-associated colitis, other super
infections (abdominal cramps, severe
watery diarrhea, fever) may result from
altered bacterial balance in GI tract.
Nephrotoxicity may occur, esp. in pts with
preexisting renal disease. Pts with history
of penicillin allergy are at increased risk
for developing a severe hypersensitivity
reaction (severe pruritus, angioedema,
bronchospasm, anaphylaxis).
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Obtain CBC, renal function tests. Ques
tion for hypersensitivity to cefixime or
other cephalosporins, penicillins.
INTERVENTION/EVALUATION
Assess oral cavity for white patches on
mucous membranes, tongue (thrush).
Monitor daily pattern of bowel activity,
stool consistency. Mild GI effects may
be tolerable (increasing severity may
indicate onset of antibiotic-associated
colitis). Monitor renal function tests for
evidence of nephrotoxicity. Be alert for
superinfection: fever, vomiting, diar
rhea, anal/genital pruritus, oral mucosal
changes (ulceration, pain, erythema).
PATIENT/FAMILY TEACHING
• Continue medication for full length of
treatment; do not skip doses. • Doses
should be evenly spaced. • May cause
GI upset (may take with food or
milk). • Report persistent diarrhea.