Name: Albuera, April Rose A.

Generic name: metronidazole Brand name: Flagyl

almost time for next dose.

Yr/Sec: BSN 3B

Preparations: PO 7.5 mg/kg q6hr (not to exceed 4g/day) CLASSIFICATION: Anti-infectives, Anti-protozoals ACTION: Disrupts DNA and protein synthesis in susceptible organisms Bactericidal, or amebicidal action INDICATION / USES: Amebicide in the management of amebic dysentery Serves as a prophylaxis against infection (surgical site is high risk) COMMON ADVERSE EFFECTS: CNS: seizures, dizziness, headache GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting Hematologic: leukopenia Skin: rashes, urticaria CONTRA-INDICATIONS: hypersensitivity NURSING CONSIDERATIONS: Administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty swallowing. Instruct patient to take medication exactly as directed evenly spaced times between dose, even if feeling better. Do not skip doses or double up on missed doses. If a dose is missed, take as soon as remembered if not

May cause dizziness or lightheadedness. Caution patient or other activities requiring alertness until response to medication is known. Inform patient that medication may cause an unpleasant metallic taste. Inform patient that medication may cause urine to turn dark. Advise patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black furry overgrowth on tongue; loose or foul-smelling stools develop). Discontinue therapy immediately if symptoms of CNS toxicity (see Appendix F) develop. Monitor especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities). Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a second course is necessary. Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of CHF. Monitor patients on lithium for elevated lithium levels. Report appearance of candidiasis or its becoming more prominent with therapy to physician promptly. Repeat feces examinations, usually up to 3 months, to ensure that amebae have been eliminated.

Generic name: paracetamol Brand name: Aeknil, Biogesic, Calpol, Neo-kiddielets, Tempra Classification: Analgesic and Antipyretic Mechanism of action: Inhibits prostaglandin synthesis in the CNS and blocks the pain impulse through a peripheral action. It acts on the hypothalamic heat-regulating center, producing peripheral vasodilation. It results in antipyresis and produces analgesic effect. Indications: Fever, Relief of mild to moderate pain like headaches, muscular aches and pain, toothache, colds, earache, fever due to tonsillectomy, inoculations, and vaccinations. Side effects: Cramping, heartburn, abdominal distention can be experienced. On a rarity, hypersensitivity reactions. Adverse reactions: Early signs of toxicity: Anorexia, nausea, diaphoresis (excessive sweating), generalized weakness within the first 12-24 hours. Late signs of toxicity: Vomiting, right upper quadrant tenderness, elevated liver function tests within 4872 hours after ingestion. Antidote: Acetylcysteine. Contraindications: Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, and pregnancy, lactation. Nursing Considerations: If to be given as analgesia, assess onset, type, location, duration of pain. Can be given without regards to meals. Tablets can be crushed. Assess temperature directly before and 1 hour after giving medication. If respirations are <12/min (<20/min in children), withhold the medication and contact the physician. Evaluate for therapeutic response: relief of pain, stiffness, swelling; increasing in joint mobility; reduced joint tenderness; improve grip strength. Therapeutic blood serum level: 1030 mcg/mL; toxic serum level: >200 mcg/mL. Patient Teaching: Consult physician for use in children less than 2 years old; oral use more than 5 days for children, more than 10 days for adults, or fever more than 3 days. Do not crush or chew sustainedrelease or enteric-coated form. Report ringing in ears and persistent GI pain. Severe, recurrent pain or high continuous fever may indicate serious illness.

Generic name: cefuroxime Brand name: Aeruginox, Altacef, Ambixime, Bactipoz, Cefogen, Ceftin, Cefucil, Cefuzime, Zefur, Zinacef, and Zinnat Classifications: antiinfective; antibiot ic; second-generation cephalosporin Mechanism of action: Cefuroxime binds to bacterial membranes. It inhibits synthesis of bacterial cell wall. Indications: Cefuroxime is used to treat otitis media, respiratory tract, genitourniary tract, gynecologic, skin, and bone infections. It is also used in the treatment of speticemia, bacterial meningitis, gonorrhea, and other gonococcal infections. Cefuroxime can also be used for ampicillin-resistant influenza, perioperative prophylaxis, impetigo, acute bacterial maxillary sinusitis, and early Lyme disease. Side effects: Discomfort with IM administration Oral candidiasis (mouth and/or tongue sores) Mild diarrhea Mild abdominal cramping Vaginal candidiasis Nausea Serum sickness reaction (joint pain, fever) Allergic reactions Thrombophlebitis Adverse Reactions: Antibiotic-associated colitis Superinfection Nephrotoxicity Severe hypersensitivity reactions Contraindications: Hypersensitivity to cephalosporins and related antibiotics; pregnancy (category B), lactation.

Nursing considerations: Question for history of allergies, particularly cephalosporins and penicillins. Give without regards to meals. If GI upset occurs give with food or milk. Avoid crushing tablets due to bitter taste. Suspension must be given with food. Intramuscular injections must be administered deep IM to minimize discomfort. Assess mouth for white patches on mucous membranes and tongue. Monitor bowel activity and stool consistency carefully. Mild GI effects may be tolerable but increasing severity may indicate onset of antibiotic-associated colitis. Monitor input and output and renal function reports for nephrotoxicity. Be alert for superinfection: severe genital or anal pruritus, abdominal pain, severe mouth soreness, moderate to severe diarrhea. Patient Teachings: Discomfort may occur with IM injection. Doses should be evenly spaced. Continue antibiotic therapy for full length of treatment. May cause GI upset (may take with food or milk).

Generic Name: amlodipine Brand name: Aforbes, Alzor, Amaday, Ambloc, Amlong, Amlosyl, Bezam, Calbloc, Calcivas, Corvex, Derox, Envacar, Exford, Lodicap, Medipin, Norbloc, Norvasc, Sedipin, Stamlo, Teneze, and Vascar Classification: Calcium channel blocker, anti-hypertensive, and antianginal Mechanism of action: Amlodipine inhibits calcium movement across cell membranes of cardiac and vascular smooth muscle. It dilates coronary arteries, peripheral arteries and arterioles. Amlodipine decreases total peripheral vascular resistance by vasodilation. Indications: Amlodipine is used to manage hypertension, chronic stable angina, and vasospastic angina. It may be used alone or with other antihypertensives or anti-anginals. Side effects: Peripheral edema Headache Flushing Dizziness Palpitations Nausea Unusual tiredness or weakness Chest pain Bradycardia Orthostatic Hypotension Adverse Reactions: Excessive peripheral vasodilation Marked hypotension Reflex tachycardia Contraindications: Contraindicated in patients with known sensitivity to amlodipine. Nursing considerations: Assess baseline renal and liver function. Assess blood pressure. Assess apical pulse. Assess for peripheral edema behind medial malleolus. Assess skin for flushing. Question for headache and weakness. May be given without regards to food. Grapefruit juice may increase drug concentration. Patient Teachings: Do not abruptly discontinue medication. Compliance with therapy regimen is essential to control hypertension. Avoid tasks that require alertness or motor skills until response to drug is established. Avoid concomitant ingestion of grapefruit.

Generic Name: ciprofloxacin Brand name: Alcipro, Bacipro, Baxolyn, Baycip, Ciclodin, Cidrolex, Ciflodal, Cifloxin, Ciloxan, Ciprobay, Ciprobiotic, Ciprotor, Flosicron, Floxil, Holdestin, Hyprocel, Iprobac, Iprolan, Proseloc, Proquin, Qinosyn, Xipro, and Zyflox Classification: Fluoroquinolone and an anti-infective Mechanism of action: Ciprofloxacin inhibits DNA enzyme in susceptible microorganisms. It interferes with bacterial DNA replication. Ciprofloxacin is also bactericidal. Indications: Ciprofloxacin is used in the treatment of chronic bacterial prostatitis. It is also used in the treatment of skin or skin structure, GI tract, bone or joint, lower respiratory tract, and urinary tract infections. Ciprofloxacin is also used in the treatment of chancroid. Ciprofloxacin is also used in the treatment of infectious diarrhea, uncomplicated gonorrhea, empiric treatment of febrile neutropenia, and acute sinusitis. It can also be used for conjunctival keratitis, keratoconjunctivitis, corneal ulcers, blepharitis, dacrocystitis, blepharoconjunctivitis, and acute meibomianitis. Side effects: Nausea Diarrhea Dyspepsia Vomiting Constipation Flatulence Confusion Crystalluria Burning Crusting in the corner of eye Abdominal pain or discomfort

Headache Rash Bad taste Redness of the eyelid Confusion Hallucination Hypersensitivity reaction Insomnia Dry mouth Paresthesia

Nursing Considerations: Question for history of hypersensitivity to Ciprofloxacin or Quinolones. May be given without regards to meals. Preferred dosing time 2 hours after meals. Do not administer antacids within 2 hours of Ciprofloxacin. Encourage cranberry juice or citrus fruits. Evaluate food tolerance. Determine pattern of bowel activity. Check for dizziness, headache, visual difficulties, and tremors. Observe therapeutic response. Patient Teachings: Do not skip doses, take full course of therapy. Take with 8 oz water, drink several glasses of water between meals. Eat or drink high sources of ascorbic acid, like cranberry juice or citrus fruits, to prevent crystalluria. Do not take antacids. Shake suspension well before using. Do not chew microcapsules in suspension. Sugarless gum or hard candy may relieve bad taste. Opthalmic: A crystal precipitate may form but usually resolves in 1-7 days.

Generic name: tramadol Brand name: Amaryll, Cetodol, Clomadol, Dolcet, Dolmal, Dolotral, Dolpaz, Doltrahex, Gesidol, Mardol, Microdol, Milador, Mosepan, Pengesic, Peptrad, Plazadol, Siverol, Tracaine, Tradomal, Tradonal, Tramadin, Tramal, Tramid, Tramkor, Tramundin, Unitral, Vistra, and Vitral Classification: opiod analgesic Mechanism of action: Tramadol binds to -opiate receptors and inhibits reuptake of norepinephrine and serotonin. It reduces intensity of pain stimuli incoming from sensory nerve endings, altering pain perception and emotional response to pain. Indications: Tramadol is used to treat moderate to moderately severe pain. Side effects: Dizziness or vertigo Nausea and Vomiting Constipation Headache Somnolence Pruritus CNS Stimulation Asthenia Diaphoresis Dyspepsia Dry mouth Diarrhea Malaise Vasodilation Anorexia Flatulence Rash Visual disturbance Urinary retention or frequency Menopausal symptoms Contraindications: Should not be administered to patients who have previously demonstrated

hypersensitivity to tramadol or in cases of acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids or psychotropic drugs. Nursing considerations: Assess onset, type, location, and duration of pain. Effect of medication is reduced if full pain recurs before next dose. Assess drug history especially carbamazepine, CNS depressant medication, MAOIs. Review past medical history, especially epilepsy or seizures. Assess renal or hepatic function laboratory values. Give without regards to meals Monitor pulse and blood pressure. Assist with ambulation if dizziness or vertigo occurs. Dry crackers or cola may relieve nausea. Palpate bladder for urinary retention. Monitor pattern of daily bowel activity and stool consistency. Sips of tepid water may relieve dry mouth. Assess for clinical improvement and record onset of relief from pain. Patient Teachings: May cause dependence. Avoid alcohol and over-the-counter medications. May cause drowsiness, dizziness, and blurred vision. Avoid tasks requiring alertness and motor skills until response to drug is established. Inform physician if severe constipation, difficulty in breathing, excessive sedation, seizures, muscle weakness, tremors, chest pain, and palpitations occur.