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CLASSIFICATION Antibiotic
ACTION Hinders or kills susceptible bacteria, including many grampositive and gramnegative aerobic and anaerobic bacteria
y y y y
INDICATION Acute bacterial exacerbations of COPD Communityacquired Pneumonia Nongonococcal urethritis or cervicitis Prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with HIV infection Gonococcal urethritis or cervicitis Pelvic inflammatory disease Genital ulcer disease Acute otitis media Pharyngitis, tonsillitis Prophylaxis of bacterial endocarditis
ADVERSE EFFECTS CNS: Dizziness, vertigo, headache, seizure, anxiety, aggressive reaction, somnolence, fatigue CV: Palpitations, chest pain, QT prolongation, torsade de pointes EENT: hearing loss, tinnitus, taste perversion GI: Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, flatulence, melena, cholestatic jaundice, Pseudomembranous colitis GU: Candidiasis, vaginitis, nephritis Hematologic: Thrombocytopenia, mild neutropenia Hepatic: Hepatitis, cholestatic jaundice, hepatic necrosis, hepatic failure Skin: Rash, photosensitivity, toxic epidermal necrolysis, urticaria Other: Anaphylaxis
NURSING RESPONSIBILITIES 1. Obtain history of patient s infection before therapy and reassess regularly thereafter. 2. Do not give this drug I.M. or by I.V. bolus injection 3. Don t give with antacids 4. Tell patient that tablets or oral suspension may be taken with or without food, but that taking with food may decrease risk of nausea 5. Tell patient to take all medications as prescribed, even after he feels better 6. Instruct patient to use sunblock and avoid prolonged exposure to the sun to decrease the risk of photosensitivity reactions
NAME Warfarin
CLASSIFICATION Anticoagulant
INDICATION y Pulmonary embolism related to deep vein thrombosis, MI, rheumatic heart disease with heart valve damage, prosthetic heart valves, chronic atrial fibrillation
CONTRAINDICATION y Patients with bleeding or hemorrhagic tendencies, GI ulcerations, severe hepatic or renal disease, severe uncontrolled hypertension, subacute bacterial endocarditis, polycythemia vera, or vitamin K deficiency y Patients who have had recent eye, brain, or spinal cord injury y Pregnant women
ADVERSE EFFECTS CNS: Headache, fever GI: Nausea, vomiting, anorexia, cramps, diarrhea, mouth ulcerations, sore mouth, melena GU: hematuria, excessive menstrual bleeding Hematologic: Hemorrhage Hepatic: Hepatitis, jaundice, Skin: Dermatitis, necrosis, gangrene, alopecia, urticaria, rash
NURSING RESPONSIBILITIES 1.Assess patient s condition before starting therapy and regularly thereafter to monitor the effectiveness of the drug 2.Regularly inspect patient for bleeding gums, bruises on arms or legs, petechiae, nosebleed, melena, tarry stools, hematuria, and hematemesis 3.If patient has a fever and rash. Notify the prescriber immediately and don t give the dose 4.Instruct the patient and family to watch for signs of bleeding and to immediately notify the prescriber if they occur 5.Warn patient to avoid OTC products containing aspirin, other salicylates, or drugs that may interact with warfarin 6.Tell patient to notify prescriber if menses are heavier than usual 7. Instruct patient to read food labels. Food and enteral feedings that contain vitamin K may impair anticoagulation
NAME Spironolactone
CLASSIFICATION Aldosterone antagonist, antihypertensiv e, diagnostic aid for primary hyperaldosteron ism, diuretic
ACTION Normally, aldosterone attaches to receptors on the walls of distal convoluted tubule cells, causing sodium (Na+) and water (H20) reabsorption in the blood, as shown at left. Spironolactone competes with aldosterone for these receptors, thereby preventing sodium and water reabsorption and causing their excretion through the distal convoluted tubules, as shown below right. Increased urinary excretion of sodium and water reduces blood volume and blood pressure.
INDICATION To treat edema cause by heart failure, hepatic cirrhosis, or nephrotic syndrome To treat hypertension To aid in the diagnosis of primary Hyperaldosteronism To treat primary hyperaldosteronism To substitute as therapy for diuretic induced hypokalemia
CONTRAINDICATION Acute renal insufficiency, anuria, hyperkalemia, hypersensitivity to spironolactone or its components
ADVERSE EFFECTS CNS: Dizziness, encephalopathy, fatigue, headache EENT: Increased intraocular pressure, nasal congestion, tinnitus, vision changes ENDO: Gynecomastia GI: Abdominal pain, anorexia, constipation, diarrhea, flatulence, nausea, vomiting GU: Impotence HEME: Aplastic anemia, neutropenia RESP: Cough, dyspnea MS: Arthralgia, back and leg pain, muscle weakness, myalgia Other: Hyperkalemia
NURSING RESPONSIBILITIES Be aware that for children or patients who have trouble swallowing, pharmacist may crush spironolactone tablets, mix with flavored syrup, and dispense as a suspension.It s stable 1 month when refrigerated. In diagnosing primary aldosteronism, test is considered positive if patient s serum potassium level rises when spironolactone is given and falls when it s discontinued. Expect to evaluate patient s serum potassium level 1 week after spiraonolactone therapy begins, after each dosage adjustment, monthly for the first 3 months, quarterly for 1 year, and then every 6 months thereafter or as ordered. Notify prescriber if level exceeds 5 mEq/L or patient s renal function deteriorates (serum creatinine level exceeding 4 mg/ dl). If patient has severe heart failure, follow closely because hyperkalemia may be fatal in such patients. Evaluate spironolactone s effectiveness by assessing
blood pressure and edema. Stop drug for several days, as prescribed, before patient undergoes adrenal vein catheterization to measure serum aldosterone level and plasma renin activity. PATIENT TEACHING Instruct patient to take spironolactone with meals or milk. If patient can t swallow tablets, mention that pharmacist can crush and mix them with flavored syrup as a suspension. Teach patient who takes spironolactone for hypertension how to measure his blood pressure. Urge him to monitor it regularly and report pressure greater than 140 mm Hg systolic or 90 mm Hg diastolic to prescriber. Caution patient that he may experience dizziness during spironolactone therapy if fluid balance is altered.
NAME Methylprednisolone
ACTION Binds to intracellular glucocorticoid receptors and suppresses inflammatory and immune responses by inhibiting accumulation of neutrophils and monocytes at inflammation sites, stabilizing lysosomal membranes, suppressing the antigen response of macrophages and helper T cells, and inhibiting the synthesis of inflammatory response mediators, such as cytokines, interleukins, and prostaglandins.
INDICATION To treat ulcerative colitis To treat a wide range of immune and Inflammatory disorders, including allergic rhinitis, asthma, Crohn s disease, and systemic lupus erythematosus To treat adrenal hyperplasia To treat acute exacerbations of multiple Sclerosis To treat adrenocortical insufficiency
CONTRAINDICATION Fungal infection, hypersensitivity to methylprednisolone or its components, idiopathic thrombocytopenic purpura (I.M.)
ADVERSE EFFECTS CNS: Ataxia, behavioral changes, depression, dizziness, euphoria, fatigue, headache, Increased intracranial pressure with papilledema, insomnia, malaise, mood changes, neuropathy, paresthesia, restlessness, seizures, steroid psychosis, syncope, vertigo CV: Arrhythmias (from hypokalemia), cardiac arrest, edema, fat embolism, heart failure, hypertension, hypertrophic cardiomyopathy (premature infants), hypotension, myocardial rupture following recent MI, tachycardia, thromboembolism, thrombophlebitis EENT: Exophthalmos, glaucoma, increased intraocular pressure, nystagmus, posterior subcapsular cataracts
NURSING RESPONSIBILITIES Use cautiously in patients with congestive heart failure or renal insufficiency because sodium retention and edema can occur in patients taking a corticosteroid. Also use cautiously in patients with peptic ulcer, diverticulitis, fresh intestinal anastomoses, or nonspecific ulcerative colitis; these conditions increase risk of perforation during corticosteroid therapy. Give methylprednisolone tablets with food to minimize indigestion and GI irritation. For once-daily dosing, give in the morning to coincide with normal cortisol secretion. Expect prescriber to add an antacid or H2- receptor antagonist to regimen. Discard parenteral products that are discolored or contain particles. Discard any remaining Depo Medrol suspension after prescribed dose is drawn from vial. Inject I.M. form deep into gluteal muscle. Avoid injecting into deltoid muscle because of risk of subcutaneous atrophy. Arrange for low-sodium diet
ENDO: Adrenal insufficiency, cushingoid symptoms (moon face, buffalo hump, central obesity, supraclavicular fat pad enlargement), diabetes mellitus, growth suppression in children, hyperglycemia, negative nitrogen balance from protein catabolism GI: Abdominal distention, elevated liver enzymes, hepatomegaly, hiccups, increased peptic ulcer, ulcerative esophagitis, vomiting GU: Amenorrhea, glycosuria, menstrual irregularities, perineal burning or tingling HEME: Easy bruising, leukocytosis MS: Arthralgia; aseptic necrosis of femoral and humeral heads; Charcot-like arthropathy; compression fractures; muscle atrophy,
with added potassium, as prescribed. Protect patient from falling, especially elderly patient at risk for fractures from osteoporosis. Closely monitor patient for signs of infection because drug may mask them or may worsen systemic fungal infections or active latent disease. Be aware that chickenpox and measles can become life-threatening in patients taking a corticosteroid. Assess for possible depression or psychotic episodes during therapy. Monitor blood glucose level; dosage of insulin or oral antidiabetic drug may need to be adjusted in diabetic patient. Be aware that changes in thyroid function such as development of hypothyroidism or hyperthyroidism may require dosage adjustment in chronic therapy because metabolic clearance of methylprednisolone is affected by thyroid activity.
twitching, or weakness; myalgia; osteoporosis; spontaneous fractures; steroid myopathy; tendon rupture RESP: Pulmonary edema SKIN: Acne; allergic dermatitis; altered skin pigmentation; diaphoresis; dry, scaly skin; erythema; hirsutism; necrotizing vasculitis; petechiae; purpura; rash; scarring; sterile abscess; striae; subcutaneous fat atrophy; thin, fragile skin; urticaria Other: Activation of latent infections, anaphylaxis, angioedema, exacerbation of systemic fungal infections, hypernatremia, hypocalcemia, hypokalemia, hypokalemic alkalosis, impaired wound healing, masking of
Avoid skin testing during methylprednisolone therapy because drug may suppress reaction. PATIENT TEACHING Caution patient not to stop taking methylprednisolone abruptly or to change dosage without consulting prescriber. Tell patient to take a missed dose as soon as he remembers unless it s nearly time for the next dose. Caution against double dosing. Urge patient to notify prescriber immediately about dark or tarry stools; signs of impending adrenocortical insufficiency, such as anorexia, dizziness, fainting, fatigue, fever, joint pain, muscle weakness, or nausea; and sudden weight gain or swelling. Instruct patient not to obtain vaccinations unless approved by prescriber. Urge patient to take vitamin D, calcium supplements, or both if recommended by prescriber. Inform patient that insomnia and restlessness usually resolve after 1 to 3 weeks.
Caution patient to avoid people with contagious diseases. Explain the need for regular exercise or physical therapy to maintain muscle mass. Advise patient to carry medical identification that documents his need for long term corticosteroid therapy.
NAME Famotidine
ACTION In normal digestion, parietal cells in the gastric epithelium secrete hydrogen (H+) ions, which combine with chloride ions (Cl ) to form hydrochloric acid (HCl), as shown below left. However, HCl can inflame, ulcerate, and perforate gastric and intestinal mucosa normally protected by mucus. Famotidine, an H2-receptor antagonist, reduces HCl formation by preventing histamine from binding with H2 receptors on the surface of parietal cells, as shown below right. By doing so, drug
INDICATION To provide short-term treatment of active duodenal ulcer To prevent recurrence of duodenal ulcer To provide short-term treatment for active, benign gastric ulcer To treat gastroesophageal reflux disease (GERD) To treat esophagitis caused by gastroesophageal Reflux To treat gastric hypersecretory conditions, such as Zollinger-Ellison syndrome To prevent heartburn and indigestion To treat heartburn and indigestion
ADVERSE EFFECTS CNS: Agitation (infants), anxiety, asthenia, confusion, depression, dizziness, fatigue, fever, hallucinations, headache, insomnia, mental or mood changes, paresthesia, seizures, somnolence CV: Arrhythmias, AV block, palpitations EENT: Dry mouth, laryngeal edema, taste alteration, tinnitus GI: Abdominal pain, anorexia, cholestatic jaundice, constipation, diarrhea, elevated liver enzymes, hepatitis, nausea, vomiting GU: Decreased libido HEME: Agranulocytosis, aplastic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia MS: Arthralgia, muscle cramps RESP: Bronchospasm, dyspnea, interstitial
NURSING RESPONSIBILITIES Shake famotidine oral suspension vigorously for 5 to 10 seconds before administration. Dilute injection form (2 ml) with normal saline solution or other solution to 5 to 10 ml; give I.V. injection over at least 2 minutes. Or dilute in 100 ml of D5W and infuse over 15 to 30 minutes. Or infuse premixed injection (20 mg/50 ml normal saline solution) over 15 to 30 minutes. PATIENT TEACHING Instruct patient to store famotidine oral suspension at room temperature (below 86 F [30 C]) and to protect it from freezing. Tell her to shake the bottle vigorously for 5 to 10 seconds after adding water and right before use. Advise patient who uses Pepcid RPD to store drug in unopened package. For each dose, instruct her to open blister pack with dry hands, place a tablet on her tongue, let it dissolve, and swallow it with saliva. If patient uses chewable tablets, instruct her to chew
helps prevent peptic ulcers from forming and helps heal existing ones.
pneumonia, wheezing SKIN: Acne, alopecia, dry skin, erythema multiforme, exfoliative dermatitis, flushing, jaundice, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria Other: Anaphylaxis, angioedema, facial edema, hyperuricemia
them thoroughly before swallowing. If patient also takes antacids, instruct her to wait 30 to 60 minutes after taking famotidine, if possible, before taking antacid. Caution patient to avoid alcohol and smoking during famotidine therapy because they irritate the stomach and can delay ulcer healing. Advise patient to notify prescriber if she develops pain or has trouble swallowing or if she has bloody vomit or black stools. Caution patient not to take famotidine with other acidreducing products.