CLOXACILLIN, SODIUM

Apo-Cloxi , Cloxapen, Cloxilean, Novocloxin , Orbenin, Tegopen Classifications: antiinfective; antibiotic, natural penicillin; beta-lactam

How should I take cloxacillin?

Take cloxacillin exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you. Take each dose with a full glass of water. Take cloxacillin on an empty stomach 1 hour before or 2 hours after meals. Do not drink juice or carbonated beverages (soda) with your dose of cloxacillin. These beverages will decrease the effectiveness of the drug. Cloxacillin should be taken at evenly spaced intervals throughout the day and night to keep the level in your blood high enough to treat the infection.

Assessment & Drug Effects Determine previous exposure and sensitivity to penicillins and cephalosporins and other allergic reactions of any kind before treatment is initiated. Monitor for S&S of anaphylactoid reaction (see Appendix G) or other signs or symptoms of hypersensitivity reaction (see Appendix F) as with other penicillins. Lab tests: Periodic assessments of renal, hepatic, and hematopoietic function are advised in patients on long-term therapy. Patient & Family Education Take medication around the clock, do not miss a dose, and continue taking the medication until it is finished. Report to physician the onset of hypersensitivity reaction (see Appendix F) and superinfections. Check with physician if GI adverse effects (nausea, vomiting, diarrhea) appear. Do not breast feed while taking this drug.

GENERIC NAME: Diazepam BRAND NAME: Valium CLASSIFICATION: Antianxiety agents, anticonvulsants, sedative/hyptonics, skeletal muscle relaxants (centrally acting) DOSAGE: 10 mg IM MECHANISM OF ACTION: - Depress the CNS, probably by potentiating GABA, an inhibitory neurotransmitter. - Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways. - Has anticonvul-sant properties due to enhanced presynaptic inhibition.Therapeutic effects: (1) Relief of Anxiety (2) Sedation (3) Amnesia (4) Skeletal muscle relaxant (5) Decreased seizure activity INDICATION: -Adjunct in the management of: 1) Anxiety 2) Preoperative sedation 3) Conscious sedation - Provides light anesthesia and anterograde amnesia - Treatment of status epilepticus/ uncontrolled seizures - Skeletal muscle relaxant - Management of the symptoms of alcohol withdrawal CONTRAINDICATIONS: - Hypersensitivity - Cross-sensitivity with other benzodiazepines may occurs - Comatose patients - Pre-existing CNS depression - Uncontrolled severe painUse cautiously in: 1) Hepatic dysfunction 2) Severe renal impairment 3) History of suicide attempt or drug dependence

SIDE EFFECTS/ ADVERSE EFFECTS: - CNS: 1) dizziness 2) drowsiness 3) lethargy 4) hangover 5) headache 6) depression - EENT: 1) blurred vision - RESP: 1) respiratory depression - CV: 1) hypotension - GI: 1) constipation 2) diarrhea 3) nausea 4) vomiting - DERM: 1) rashes - LOCAL: 1) pain (IM) 2) phlebitis (IV) 3) venous thrombosis - MISC: 1) physical & psychological depen-dence 2)tolerance NURSING IMPLICATIONS/RESPONSIBILITIES: - Monitor BP, PR,RR prior to periodically throughout therapy and frequently during IV therapy. - Assess IV site frequently during administration, diazepam may cause phlebitis and venous thrombosis. - Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict amount of drug available to patient. Observe depressed patients closely for suicidal tendencies. - Observe and record intensity, duration and location of seizure activity. The initial dose of diazepam offers seizure control for 15-20 min after

administration. - IM injections are painful and erratically absorbed. If IM route is used, inject deeply into deltoid muscle for maximum absorption. - Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication. - Effectiveness of therapy can be demonstrated by decrease anxiety level; control of seizures; decreased tremulousness.

Generic and brand name: magnesium sulfate 250 mg/mL (25%) solution for injection Category: anticonvulsant Description: magnesium sulfate 250 mg/mL (25%) injection is a sterile, pyrogen-free solution of magnesium sulfate in water for injection. Formulation: Each mL contains: magnesium sulfate (anhydrous) = 250mg; water for injection, q.s. ad. = 1mL; no preservative added Mechanism of action: Magnesium sulfate inhibits convulsion by acting at the myoneural junction to prevent release of acetylcholine and to decrease the motor and plate potential. It inhibits the contraction of the uterus by directly acting on the myometrial cells and enhancing uterine blood flow. Indications: magnesium sulfate is indicated for the treatment of acute hypomagnesemia accompanied by signs of tetany, to control hypertension, encephalopathy and convulsions and for the prevention and control of convulsions in patients with pre-eclampsia or eclampsia. It is also used to prevent hypomagnesemia in patients receiving total parenteral nutrition (TPN). Dosage and administration: Magnesium deficiency, adult: 2 mL injected intramuscularly every 6 hours for 4 doses Nephritic seizures in children: 0.05 0.1 mL per kg body weight injected intramuscularly as needed Pre-eclampsia: 8 to 10 mL added into a 250 mL of 5% dextrose or 0.9% sodium chloride injection administered by intravenous infusion. Simultaneously, intramuscular dose of up to 20 mL of the undiluted solution may be given (10 mL in each buttock). Thereafter, 8 to 10 mL is injected intramuscularly into alternate buttocks depending on the presence of patellar reflex and adequate respiratory function. Therapy should be continued until paroxysms cease. Appropriate reduction in dosage should be made for patients with renal impairment.

Note: an isotonic solution of Magnesium Sulfate may be prepared by aseptically adding 7.3 mL of Magnesium Sulfate 250mg/mL injection to a 50mL of Sterile water for injection of other suitable parenteral solvent. Pharmacokinetics: About one third or orally administered Magnesium Sulfate is absorbed which is enhanced by the presence of the Vitamin D compound Calcitrol. It readily crosses the placenta but rarely causes toxicity to the neonate. Toxicity in the mother is indicated by the loss of patellar reflex which occurs when the blood level of magnesium is between 7 to 10 mEq/L. Adverse effects: Adverse effects due to high level of magnesium ion include flushing, sweating, hypotension, muscular weakness, sedation and confusion. As the blood level begins to exceed 4 mEq/L, deep tendon reflexes are decreased which may be absent at 10mEq/L. At 12 to 15 mEq/L, respiratory paralysis is a potential hazard. Treatment of Adverse effects: An injectable solution of calcium salt (i.e. as gluconate) should always be available for use as antidote. Calcium salt injection should be administered intravenously at a dose of up to 10mEq to counteract respiratory depression or heart block. If renal function is normal, adequate fluid should be given to assist removal of magnesium from the body. Dialysis may be necessary in patients with renal impairment or severe hypermagnesemia. Precaution: Use with extreme caution to patients with impaired renal function and those receiving digitalis glycosides. Magnesium Sulfate injection may enhance the effects of neuromuscular blocking agents. Contraindication: Magnesium Sulfate injection is contraindicated to patients with heart block or myocardial damage. Caution: foods drugs, devices and cosmetics act prohibits dispensing without prescription Storage condition: store at temperatures not exceeding 30 degrees Celsius. Availability: magnesium sulfate 250mg/mL (25%) injection is available in clear vials with 10 mL content.