Generic Name azithromycin Peak 2.1 to 3.

2 hours

Trade Name Zithromax Onset Rapid

Classification Bactericidal

Duration 24 hours

Dose Route Time/frequency 1 g packet oral 1 time with 2oz water Normal dosage range 250 600 mg tablets, or 100mg/5 ml in 150ml bottles, 200 mg/5ml in 15-ml, 22.5-ml and 30ml bottles For IV meds, compatibility with IV drips and/or solutions Nursing Implications (what to focus on) Contraindications/warnings/interactions Hypersensitivity to drug, erythromycin, or other macrolide anti-infectives Common side effects hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Why is your patient getting this medication Is indicated for the treatment of patients with mild to moderate infections Mechanism of action and indications (Why med ordered) Bactericidal and bacteriostatic; inhibits protein synthesis after binding with 50S ribosomal subunit of susceptible organisms. Demonstrates crossresistance to erythromycin-resistant gram-positive strains and resistance to most strains of Enterococcus faecalis and methicillinresistant Staphylococcus aureus. Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) severe hepatic impairment, severe renal insufficiency, prolonged QT interval breastfeeding patients.

Lab value alterations caused by medicine

Nursing Process- Assessment (Pre-administration assessment) Obtain specimens for culture and sensitivity testing before starting therapy.

Be sure to teach the patient the following about this medication Tell patient he may take tablets with or without food. Advise patient to take suspension 1 hour before or 2 hours after meals. Remind patient to complete entire course of therapy as ordered, even after symptoms improve. As appropriate, review all other significant and lifethreatening adverse reactions and interactions, especially those related to the drugs, foods, and behaviors mentioned above. Assessment Evaluation Why would you hold or not give this Check after giving med? Monitor temperature, white blood cell count, and culture and sensitivity results. Assess for signs and symptoms of infection

Generic Name carvedilol Peak 1-2 hours

Trade Name Classification Dose Route Coreg Beta-blocker 3.125 mg Oral Onset Duration Normal dosage range 1 hour 15 hours 3.125-50 mg

Time/frequency b.i.d/2 weeks

Why is your patient getting this medication For IV meds, compatibility with IV drips and/or COREG (carvedilol) is indicated for the treatment of solutions mild-to-severe chronic heart failure. Mechanism of action and indications (Why med ordered) Coreg is indicated for the treatment of mild-tosevere chronic heart failure of ischemic or cardiomyopathic origin, usually in addition to diuretics, ACE inhibitors, and digitalis, to increase survival and, also, to reduce the risk of hospitalization Nursing Implications (what to focus on) Contraindications/warnings/interactions Bronchial asthma or related bronchospastic conditions. Deaths from status asthmaticus have been reported following single doses of Coreg. Second- or third-degree AV block Sick sinus syndrome Severe bradycardia Patients with cardiogenic shock or who have decompensated heart failure requiring the use of intravenous inotropic therapy. Such patients should first be weaned from intravenous therapy before initiating Coreg. Patients with severe hepatic impairment Patients with a history of a serious hypersensitivity reaction Common side effects Low blood pressure (which may cause dizziness or fainting when you stand up). If these happen, sit or lie down right away and tell your doctor. Tiredness. If you feel tired or dizzy you should not drive, use machinery, or do anything that needs you to be alert. Slow heartbeat. Changes in your blood sugar. If you have diabetes, tell your doctor if you have any changes in your blood sugar levels. Coreg may hide some of the symptoms of low blood sugar, especially a fast heartbeat. Lab value alterations caused by medicine

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) CYP2D6 Inhibitors and Poor Metabolizers Hypotensive Agents Cyclosporine Digitalis Glycosides Inducers/Inhibitors of Hepatic Metabolism Amiodarone Calcium Channel Blockers Insulin or Oral Hypoglycemics Anesthesia

Be sure to teach the patient the following about this medication Make sure they take the medication with food. This medication will slow their heart rate. If you feel dizzy or light headed make sure you tell us immediately.

Nursing Process- Assessment (Pre-administration assessment) Check blood pressure

Assessment Why would you hold or not give this med? If blood pressure is low I will not give this medication.

Evaluation Check after giving Check blood pressure after giving medication.

Generic Name Levothyroxine Sodium

Trade Name Synthroid

Classification T4 (synthetic) Hormone

Dose
100mcg

Route P.O

Time/frequency
1.7 mcg/kg qd, 30 minutes to 1 hour before

breakfast

Peak 1-3 weeks I.V.: ~24 hours

Onset Duration Oral: 3-5 1-3 weeks days; I.V. 68 hours Why is your patient getting this medication Treatment of thyroid hormone deficiency (hypothyroidism) Mechanism of action and indications (Why med ordered) The active ingredient in Synthroid is called levothyroxine sodium. It is a synthetic hormone intended to replace a hormone that is normally produced by the patients thyroid gland thyroxine. The thyroid hormones have both catabolic (calorigenic) and anabolic effects and are therefore involved in normal metabolism, growth, and development, especially the development of the central nervous system (CNS) of infants.

Normal dosage range Average starting dose ~100 mcg; usual doses are </=200 mcg/day; doses >/=300 mcg/day are rare For IV meds, compatibility with IV drips and/or solutions For I.V. administration, give each 100 mcg over at least 1 minute. Nursing Implications (what to focus on) Contraindications/warnings/interactions Contradictions: Uncorrected adrenal insufficiency. Untreated thyrotoxicosis. Acute MI Warnings: Not for treatment of obesity or infertility. Cardiovascular disease. Seizures. Adrenocortical insufficiency. Increased sensitivity in severe hypothyroidism. Autonomous thyroid tissue. Elderly. Pregnancy (Cat. A); do not discontinue due to pregnancy. Nursing mothers Interactions: Absorption reduced by some foods (e.g., soy, fiber), aluminum and magnesium hydroxide, simethicone, calcium carbonate, sodium polystyrene sulfonate, bile acid sequestrants, iron, sucralfate (give at least 4 hrs apart). Potentiates, and is potentiated by, tri- and tetracyclic antidepressants, sympathomimetics. Antagonized by hepatic enzyme inducers (e.g., carbamazepine, phenytoin, phenobarbital, rifampin), sertraline. Antagonizes digoxin. Marked hypertension and tachycardia with ketamine. Estrogens affect thyroid function tests. Monitor oral anticoagulants, antidiabetic agents, theophylline Common side effects Allergic reaction (skin rash or hives) hyperthyroidism or overdosage, (changes in appetite; changes in menstrual periods; chest pain; diarrhea; fast or irregular heartbeat; fever; hand tremors; headache; irritability ; leg cramps; nervousness; sensitivity to heat; shortness of breath; sweating; trouble in sleeping; vomiting ; weight loss)

pseudotumor cerebri, in children (severe headache) Those indicating need for medical attention only if they continue or are bothersome Hypothyroidism or underdosage (changes in menstrual periods ; clumsiness; coldness; constipation; dry, puffy skin; headache ; listlessness; muscle aches; sleepiness; tiredness; weakness; weight gain) Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)

Lab value alterations caused by medicine Monitor thyroid function studies prior to and during therapy. Antacids or gas-relieving medications Blood and Urine Glucose in Diabetic patients Insulin or oral hypoglycemic dose may need to be Antidepressants increased Calcium Be sure to teach the patient the following about this Certain seizure medications, such as: medication 1. Take Synthroid as a single dose, preferably on an empty stomach, one-half to one hour before breakfast. Levothyroxine absorption is increased on an empty stomach. 2. If patient can't swallow tablets, crush them and sprinkle onto small amount of food, such as applesauce. 3. It may take several weeks before you notice an improvement in your symptoms. 4. Notify your physician if you experience any of the following symptoms: rapid or irregular heartbeat, chest pain, shortness of breath, leg cramps, headache, nervousness, irritability, sleeplessness, tremors, change in appetite, weight gain or loss, vomiting, diarrhea, excessive sweating, heat intolerance, fever, changes in menstrual periods, hives or skin rash, or any other unusual medical event. 5. Notify your physician if you become pregnant while taking Synthroid. It is likely that your dose of Synthroid will need to be increased while you are pregnant. 6. Notify your physician or dentist that you are taking Synthroid prior to any surgery. 7. Partial hair loss may occur rarely during the first few months of Synthroid therapy, but this is usually temporary. 8. Synthroid should not be used as a primary or

Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol) o Phenobarbital (Luminal) o Phenytoin (Dilantin, Phenytek)
o

Cholestyramine (Prevalite, Questran, Questran Light) Colestipol (Colestid) Diabetes medications Digoxin (Digitek, Lanoxin) Estrogens, such as birth control pills, patches, rings, or hormone replacement therapy Iron Orlistat (Alli, Xenical) Raloxifene (Evista) Rifampin (Rifadin) Sucralfate (Carafate)

Theophylline (Uniphyl, Theocron, TheoCap, Theo-24, Elixophyllin) Warfarin (Coumadin, Jantoven).

adjunctive therapy in a weight control program. 9. Keep Synthroid out of the reach of children. Store Synthroid away from heat, moisture, and light. 10. Agents such as iron and calcium supplements and antacids can decrease the absorption of levothyroxine sodium tablets. Therefore, levothyroxine sodium tablets should not be administered within 4 hours of these agents. 11. Explain that patient may require lifelong therapy and must undergo regular blood testing. 12. Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

Nursing Process- Assessment (Pre-administration assessment) 1) Conduct TSH test for diagnosing hypothyroidism. It's a simple blood test that checks the level of thyroid-stimulating hormone (TSH) in the blood 2) Assess apical pulse and blood pressure prior to and periodically during therapy. 3) Ask the patient about any medication and food allergies, all medications they are taking, pregnancy plans, and all medical conditions they may have, especially heart disease, diabetes, clotting disorders, and adrenal or pituitary gland problems

Assessment Why would you hold or not give this med? If the patient is pregnant, allergic to thyroid hormones, breast feeding, overdosed

Evaluation Check after giving -Conduct TSH test to test TSH level every 6-8 weeks -Check vital signs and ECG routinely. - Monitor thyroid and liver function tests. Evaluate for signs and symptoms of overdose, including those of hyperthyroidism (weight loss, cardiac symptoms, abdominal cramps). - Monitor closely for drug efficacy. - Watch for signs and symptoms of bleeding tendency, especially if patient is receiving anticoagulants concurrently.