A.

DRUG STUDY

Classification Brand Name: ApoMetronidazole (CAN), Flagyl, Flagyl 375, Flagyl ER, Flagyl IV, Flagyl IV RTU, MetroCream (CAN), MetroGel, Metro I.V., Neo-Tric (CAN), NidaGel (CAN), Noritate, Novonidazol (CAN), PMSMetronidazole (CAN), Protostat, Trikacide (CAN)

Therapeutic actions
Bactericidal: inhibits DNA synthesis in specific (obligate) anaerobes, causing cell death; antiprotozoaltrichomonacidal, amebicidal: biochemical mechanism of action is not known.

Indications
Acute infection with susceptible anaerobic bacteria Acute intestinal amebiasis Amebic liver abscess Trichomoniasis (acute and partners of patients with acute infection) Preoperative, intraoperative, postoperative prophylaxis for patients undergoing colorectal surgery Topical application in the treatment of inflammatory papules, pustules, and erythema of rosacea Unlabeled uses:

Contraindications
Contraindicated with hypersensitivity to metronidazole; pregnancy (do not use for trichomoniasis in first trimester). Use cautiously with CNS diseases, hepatic disease, candidiasis (moniliasis), blood dyscrasias, lactation.

Dosages
IV Metronidazole Dosage for Anaerobic Infections For serious anaerobic infections, metronidazole is usually given by IV in a hospital (at least at first). For the oral forms, the recommended dose for treating anaerobic infections is based on weight: 7.5 mg per kg of body weight (about 3.4 mg per pound) every 6 hours, up to a maximum of 4000 mg in any given 24-hour period. The medication is

Adverse effects
Headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizures, peripheral neuropathy, fatigue Unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset, cramps Dysuria, incontinence, darkening of the urine Thrombophlebitis (IV); redness, burning, dryness, and skin irritation (topical) Severe, disulfiramlike interaction with alcohol, candidiasis (superinfection)

Nursing Responsibility
Avoid use unless necessary. Metronidazole is carcinogenic in some rodents. Administer oral doses with food. Apply topically (MetroGel, MetroCream) after cleansing the area. Advise patient that cosmetics may be used over the area after application. Reduce dosage in hepatic disease.

Pregnancy Category B

Drug classes: Antibiotic, Antibacterial, Amebicide, Antiprotozoal

prophylaxis for patients undergoing gynecologic, abdominal surgery; hepatic encephalopathy; Crohn's disease; antibioticassociated pseudomembranous colitis; treatment of Gardnerella vaginalis, giardiasis (use recommended by the CDC)

usually taken for 7 to 10 days, although some infections may require extended treatment.

Oral Dose for Amebic Infections For amebic dysentery, the recommended metronidazole dose is 750 mg three times a day for 5 to 10 days. For an amebic liver abscess, the recommended dose is 250 to 500 mg three times daily for 5 to 10 days. For treating amebic infections in children, your child's healthcare provider will

calculate an appropriate amount based on your child's weight.

Classification
Protexin Probiotics

Therapeutic actions
Many people use probiotics to prevent diarrhea, gas, and cramping caused by antibiotics. Antibiotics kill "good" (beneficial) bacteria along with the bacteria that cause illness. A decrease in beneficial bacteria may lead to digestive problems. Taking probiotics may help replace the lost beneficial bacteria. This can help prevent diarrhea. A decrease in beneficial bacteria may also lead to other infections,

Indications
Probiotics, or friendly or good bacteria, are live microorganisms that can be used as complementary and alternative medicine to treat illnesses such as vaginal infections, tooth decay, H. pylori infection, irritable bowel syndrome, infectious diarrhea, and inflammatory bowel diseases like ulcerative colitis and Crohn's disease.

Contraindications
For people with suppressed immune systems due to disease or treatment for a disease (such as cancer chemotherapy), taking probiotics may actually increase your chances of getting sick. Always speak with your doctor before taking any supplement under these circumstances.

Dosages
2 cap/chewable tab daily or 1 sachet daily.

Adverse effects
Probiotics are often regulated as dietary supplements rather than as pharmaceuticals or biological products. Thus, there is usually no requirement to demonstrate safety, purity, or potency before marketing probiotics. Infection Reports of sepsis related to probiotic use

Nursing Responsibility
Check for signs of hypersensitivity

Risk factors for probiotic sepsis

Deleterious metabolic activities

such as vaginal yeast and urinary tract infections, and symptoms such as diarrhea from intestinal illnesses. Probiotics may also be used to: Help with other causes of diarrhea. Help prevent infections in the digestive tract. Help control immune response (inflammation), as in inflammatory bowel disease (IBD).

Immune deviation or excessive immune stimulation

Microbial resistance

Classification

Therapeutic actions

Indications

Contraindications

Dosages

Adverse effects

Nursing Responsibility Assessment History: Allergy to acetaminophen, impaired hepatic function, chronic alcoholism, pregnancy, lactation Physical: Skin color, lesions; T; liver evaluation; CBC, LFTs, renal function tests Interventions Do not exceed the recommended dosage. Consult physician if needed for children < 3 yr; if needed for longer than 10 days; if continued fever, severe or recurrent pain occurs (possible serious illness).

Generic Name: Decreases Paracetamol, fever by a Acetaminophen hypothalamic effect leading Brand Name: to sweating Biogesic, and Panadol, vasodilation Tylenol Inhibits Classification: pyrogen effect Non-narcotic on the analgesic, hypothalamicAntipyretic heatregulating centers Inhibits CNS prostaglandin synthesis with minimal effects on peripheral prostaglandin synthesis Does not cause

Analgesicantipyretic in patients with aspirin allergy, hemostatic disturbances, bleeding diatheses, upper GI disease, gouty arthritis Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks clinically significant antirheumatic and antiinflammatory effects) Common cold, flu, other viral and bacterial infections with pain and fever

Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation.

PO or PR By suppository, 325650 mg q 46 hr or PO, 1,000 mg tid to qid. Do not exceed 4 g/day. PEDIATRIC PATIENTS PO or PR Doses may be repeated 45 times/day; do not exceed five doses in 24 hr; give PO or by suppository. Age Dosage (mg) 03 mo 40 411 mo 80 1223 mo 120 23 yr 160 45 yr 240 68 yr 320

CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 58 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Hematologic: Methemoglobinemia cyanosis; hemolytic anemiahematuria, anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia,

ulceration of the GI tract and causes no anticoagulant action.

Unlabeled use: Prophylactic for children receiving DPT vaccination to reduce incidence of fever and pain

910 yr 400 11 yr 480

hypoglycemia Hypersensitivity: Rash, fever

Avoid using multiple preparations containing acetaminophen. Carefully check all OTC products. Give drug with food if GI upset occurs. Discontinue drug if hypersensitivity reactions occur. Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should be available as a specific antidote; basic life support measures may be necessary. Teaching points Do not exceed recommended dose; do not take for longer than 10 days. Take the drug only for complaints indicated; it is not

an antiinflammatory agent. Avoid the use of other overthe-counter preparations. They may contain acetaminophen, and serious overdosage can occur. If you need an over-thecounter preparation, consult your health care provider. Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in voiding patterns.

Classification Generic Name: Zn sulfate monohydrate Brand Name: E-Zinc [drops

Therapeutic actions
E-Zinc contains zinc. Zinc helps the body's natural defense against damaging free radicals (antioxidant effect) and helps boost immune function. Free radicals are highly reactive and unstable chemicals generated during normal body activities that require oxygen (eg, respiration, digestion, blood circulation, immune system response, etc) and after exposure to ultraviolet (UV) light, cigarette

Indications
Dietary supplementation; supplement to IV solutions given for TPN; treatment or prevention of zinc deficiencies. Ophthalmic solution used as mild astringent for relief of eye irritation.

Contraindications
HIV (human immunodeficiency virus)/AIDS: Do not take zinc if you have HIV/AIDS. Zinc might shorten your life. Allergy to any component of EZinc.

Dosages
BY MOUTH: For treating the common cold: one zinc gluconate or acetate lozenge, providing 9-24 mg elemental zinc, dissolved in the mouth every two hours while awake when cold symptoms are present. For diarrhea in malnourished or zinc-deficient children: 10-40 mg elemental zinc daily. For preventing and treating pneumonia in undernourished children in developing countries: 10-70

Adverse effects
Taking high amounts of zinc is LIKELY UNSAFE. High doses above the recommended amounts might cause fever, coughing, stomach pain, fatigue, and many other problems. Taking more than 100 mg of supplemental zinc daily or taking supplemental zinc for 10 or more years doubles the risk of developing prostate cancer. There is also concern that taking large amounts of a multivitamin plus a separate zinc supplement increases the

Nursing Responsibility
Tell patient to contact health care provider if nausea, severe vomiting, dehydration, or restlessness occurs. Identify food sources of zinc (eg, seafood, organ meats, wheat germ). Inform patient that sense of taste and smell, skin hydration, and wound healing should improve. Instruct patient to follow RDA guidelines and limitations in terms of vitamin

smoke and various pollutants. One major effect of zinc is on the ability of cells to properly replicate the deoxyribonucleic acid(DNA), which is required for cells to multiply. Hence, zinc is needed for normal growth. Zinc has other known functions/effects: Cofactor of various enzymes in cell division and growth. Required for the normal development and maintenance of the immune system; helps regulate the activity of cells

mg/day. For hypogeusia (sense of taste is abnormal): 25-100 mg zinc. For the eating disorder anorexia nervosa: 100 mg of zinc gluconate daily. For treating stomach ulcers: zinc sulfate 200 mg three times daily. For muscle cramps in zinc deficient people with liver disease: zinc sulfate 220 mg twice daily. For osteoporosis: 15 mg zinc combined with 5 mg manganese, 1000 mg calcium, and 2.5 mg copper has been used. For sickle cell

chance of dying from prostate cancer. Taking 450 mg or more of zinc daily can cause problems with blood iron. Single doses of 1030 grams of zinc can be fatal

and mineral supplementation. Tell patient to take with food if GI upset occurs, but to avoid foods high in calcium, phosphorus, and phytate. Inform patient that bran, caffeine, and dairy products may decrease absorption. Tell patient to notify health care provider if change in vision occurs or if eye irritation or pain persists or increases while using ophthalmic solution. Advise patient that parenteral medication will

involved in immune function. Functions as an antioxidant by being a cofactor of the enzyme super oxide dismutase, which is involved in the removal of harmful free radicals. Zinc is also recommended by the World Health Organization (WHO) and UNICEF as an adjunct in acute diarrhea management together with reduced osmolarity oral rehydration salts (ORS).

disease: zinc sulfate 220 mg three times daily. To increase growth and weight gain in children with sickle cell disease who have not reached puberty: 10 mg elemental zinc per day. For treating attention deficithyperactivity disorder (ADHD) in children: doses of zinc sulfate 55 mg (15 mg elemental zinc) to 150 mg (40 mg elemental zinc) daily. For treating acne: 30-135 mg elemental zinc daily. For treating agerelated macular degeneration

be prepared and administered by a health care provider in a hospital setting. Teach patient proper administration technique for eye drops.

(AMD): elemental zinc 80 mg plus vitamin C 500 mg, vitamin E 400 IU, and beta-carotene 15 mg daily.

B. IV INFUSION
CLASSIFICATION 5 % dextrose and 0.3 NaCl Hypotonic Water replacement DKA Gastric fluid loss from NG or vomiting INDICATION Fluid challenges, Fluid replacement in patient with DKA, Hyponatremia, shock CONTRAINDICATION Dont use with liver disease, trauma, or burns. May cause cardiovascular collapse or increased intracranial pressure NURSING RESPONSIBILITIES Use with caution

5% dextrose with multiple balance solution Isotonic Fluid loss Dehydration Hypernatremia

For dehydration For patient with respiratory problems ION multiple balance All ions either positive or negative are present

Use cautiously in renal and cardiac patients Can cause fluid overload

Do not use to patient without case of dehydration