LIVOLIN FORTE

Action: Involves in the process of transmethylation , hydrogen transport, synthesis of methionine, nucleic acid, choline and creatine. Contributes to accumulation of erythrocytes. Has beneficial effect on liver and nervous system. Indication: Anemia, hepatitis, cirrhosis, cerebral palsy Down syndrome, skin diseases, Side Effects/ Adverse Effect: Pain in the heart, tachycardia, urticarial Contraindication: Hypersensitivity and thromboembolism Nursing Consideration 1. 2. Monitor blood coagulation profile regularly. Cautious to patient with hypersensitivity to the said drug. Consist of lecithin, vitamin B1, 12, 2, 3, 6, vit e.

Acetylcysteine
ACTION Mucolytic that reduces the viscosity of pulmonary secretions by splitting disulfide linkagesbetween mucoprotein molecular complexes. Also, restores liver stores of glutathione to treatacetaminophen toxicity. BRAND NAME Acetadote, Mucomyst CLASSIFICATION Miscellaneous respiratory tract drugs

INDICATION Adjunct therapy for abnormal viscid or thickened mucous secretions in patients withpneumonia, bronchitis, bronchiectasis, primary amyloidosis of the lung, tuberculosis, cysticfibrosis, emphysema, atelectasis, pulmonary complications of thoracic surgery, or CVsurgery Acetaminophen toxicity Adults and children: CONTRAINDICATION Contraindicated in patients hypersensitive to drug. Use cautiously in elderly or debilitated patients with severe respiratory insufficiency. Use I.V.formulation cautiously in patients with asthma or a history of bronchospasm. SIDE EFFECTS/ ADVERSE REACTIONS CNS: fever, drowsiness, abnormal thinking, gait disturbances CV: tachycardia, hypotension, hypertension, flushing, chest tightness EENT: rhinorrhea, ear pain, eye pain, pharyngitis, throat tightness GI: stomatitis, nausea, vomiting Respiratory: rhonchi, bronchospasm, cough, dyspnea Skin: rash, clamminess, diaphoresis, pruritus, urticaria Other: angioedema, chills, anaphylactoid reaction NURSING RESPONSIBILITY 1. Observe 10 rights in drug administration. 2. Use plastic, glass, stainless steel, or another nonreactive metal when giving by nebulization.Hand-bulb nebulizers arent recommended because output is too small and particle size toolarge. 3. Drug is physically or chemically incompatible with tetracyclines, erythromycin lactobionate,amphotericin B, and ampicillin sodium. If given by aerosol inhalation, nebulize these

Generic Names & Brand

azithromycin Zithromax Pregnancy Category B Drug class Macrolide antibiotic Therapeutic actions Bacteriostatic or bactericidal in susceptible bacteria. Indications Treatment of LRIs: Acute bacterial exacerbations of COPD due to H. influenzae, Moraxella catarrhalis,

Tablets250, 600 mg; powder for injection500 mg; powder for oral suspension100 mg/5 mL, 200 mg/5 mL, 1 g/packet Dosages ADULTS

Mild to moderate acute bacterial exacerbations of COPD, pneumonia, pharyngitis and tonsillitis (as second-line): 500 mg PO single dose on first day,
followed by 250 mg PO daily on days 25 for a total dose of 1.5 g or 500 mg/day PO for 3 days.

Nongonococcal urethritis and cervicitis due to C. trachomati: A single 1-g PO dose. Gonococcal urethritis and cervicitis: A single dose
of 2 g PO.

S. pneumoniae; community-acquired pneumonia due

to S. pneumoniae, H. influenzae Treatment of LRIs: Streptococcal pharyngitis and tonsillitis due to Streptococcus pyogenes in those who cannot take penicillins Treatment of uncomplicated skin infections due to Staphylococcus aureus, S. pyogenes,

Disseminated MAC infections: For prevention,

1,200 mg PO taken once weekly. For treatment, 600 mg/day PO with etambutol.

Acute sinusitis: 500 mg/day PO for 3 days. Adverse effects CNS: Dizziness, headache, vertigo, somnolence, fatigue GI: Diarrhea, abdominal pain, nausea, dyspepsia, flatulence, vomiting, melena, pseudomembranous colitis Other: Superinfections, angioedema, rash, photosensitivity, vaginitis Nursing considerations Assessment History: Hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic; gonorrhea or syphilis, pseudomembranous colitis, hepatic or renal impairment, lactation Physical: Site of infection; skin color, lesions; orientation, GI output, bowel sounds, liver evaluation; culture and sensitivity tests of infection, urinalysis, liver and renal function tests Interventions Culture site of infection before therapy. Administer on an empty stomach 1 hr before or 23 hr after meals. Food affects the absorption of this drug. Counsel patients being treated for STDs about appropriate precautions and additional therapy. Teaching points

Streptococcus agalactiae
Treatment of nongonococcal urethritis and cervicitis due to C. trachomatis; treatment of PID Treatment of acute sinusitis Treatment of otitis media caused by H. influenzae,

M. catarrhalis, S. pneumoniae in children > 6 mo

Treatment of pharyngitis and tonsillitis in children > 2 yr who cannot use first-line therapy Prevention and treatment of disseminated Mycobacterium avium complex (MAC) in patients with advanced AIDS Unlabeled uses: Uncomplicated gonococcal infections caused by N. gonorrhoeae; gonococcal pharyngitis caused by N. gonorrhoeae; chlamydial infections caused by C. trachomatis; prophylaxis after sexual attack Contraindicated with hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic. Use cautiously with gonorrhea or syphilis, pseudomembranous colitis, hepatic or renal impairment, lactation. Available forms

Contraindications and cautions

Take the full course prescribed. Do not take with antacids. Take with food if GI upset occurs. You may experience these side effects: Stomach cramping, discomfort, diarrhea; fatigue, headache (medication may help); additional infections in the mouth or vagina (consult with health care provider for treatment).

Report severe or watery diarrhea, severe nausea or vomiting, rash or itching, mouth sores, vaginal sores.

Generic Name:Lactulose(laktyoo-lose) Brand Name:Cephulac, Chronulac ,Movelax,Lilac Classifications:gastrointestinal agent; hyperosmotic laxative Pregnancy Category:C Availability 10 g/15 mL solution, syrup Actions Reduces blood ammonia; appears to involve metabolism of lactose to organic acids by resident intestinal bacteria. Therapeutic effects Acidifies colon contents, which retards diffusion of nonionic ammonia (NH3) from colon to blood while promoting its migration from blood to colon. In the acidic colon, NH3 is converted to nonabsorbable ammonium ions (NH4) and is then expelled in feces by laxative action. Decreased blood ammonia in a patient with hepatic encephalopathy is marked by improved EEG patterns and mental state (clearing of confusion, apathy, and irritation). Osmotic effect of organic acids causes laxative action, which moves water from plasma to intestines, softens stools, and stimulates peristalsis by pressure from water content of stool. Uses Prevention and treatment of portal-systemic encephalopathy (PSE), including stages of hepatic precoma and coma, and by prescription for relief of chronic constipation. Cautious use Diabetes mellitus; concomitant use with electrocautery procedures (proctoscopy, colonoscopy); older adult and debilitated patients; pediatric use.

Chronic Constipation adult:PO 3060 mL/d prn child:PO 7.5 mL/d after breakfast Administration Oral Give with fruit juice, water, or milk (if not contraindicated) to increase palatability. Laxative effect is enhanced by taking with ample liquids. Avoid meal times. Rectal Administer as a retention enema via a rectal balloon catheter. If solution is evacuated too soon, instillation may be promptly repeated. Do not freeze. Avoid prolonged exposure to temperatures above 30C (86F) or to direct light. Normal darkening does not affect action, but discard solution that is very dark or cloudy. Adverse effects GI:Flatulence,borborygmi,belching,abdominal cramps,pain,and distention (initial dose);diarrhea (excessive dose); nausea, vomiting, colon accumulation of hydrogen gas; hypernatremia. Nursing implications Assessment & Drug Effects In children if the initial dose causes diarrhea, dosage is reduced immediately. Discontinue if diarrhea persists. Promote fluid intake (>=15002000 mL/d) during drug therapy for constipation; older adults often self-limit liquids. Lactulose-induced osmotic changes in the bowel support intestinal water loss and potential hypernatremia. Discuss strategy with physician. Patient & Family Education Laxative action is not instituted until drug reaches the colon; therefore, about 2448 h is needed. Do not self-medicate with another laxative due to slow onset of drug action. Notify physician if diarrhea (i.e., more than 2 or 3 soft stools/d) persists more than 2448 h. Diarrhea is a sign of overdosage. Dose adjustment may be indicated. Do not breast feed while taking this drug without consulting physician.

Generic Name:Omeprazole(o-mepra-zole) Brand Name:Losec,Prilosec Classifications:gastrointestinal agent; proton pump inhibitor Pregnancy Category:C Availability: 10 mg, 20 mg, 40 mg capsules Actions An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid secretion by inhibiting the H+, K+-ATPase enzyme system [the acid (proton H+) pump] in the parietal cells. Therapeutic effects Suppresses gastric acid secretion relieving gastrointestinal distress and promoting ulcer healing. Uses Duodenal and gastric ulcer. Gastroesophageal reflux disease including severe erosive esophagitis (4 to 8 wk treatment). Long-term treatment of pathologic hypersecretory conditions such as Zollinger-Ellison syndrome, multiple endocrine adenomas, and systemic mastocytosis. In combination with clarithromycin to treat duodenal ulcers associated with Helicobacter pylori. Contraindications Long-term use for gastroesophageal reflux disease, duodenal ulcers; lactation. Route & dosage Gastroesophageal Reflux, Erosive Esophagitis, Duodenal Ulcer adult: PO 20 mg once/d for 48 wk Gastric Ulcer adult: PO 20 mg b.i.d. for 48 wk Hypersecretory Disease adult:PO 60 mg once/d up to 120 mg t.i.d. Duodenal Ulcer Associated with H. pylori adult:PO 40 mg once/d for 14 d, then 20 mg/d for 14 d, in combination with clarithromycin 500 mg t.i.d. for 14 d Administration Oral Give before food, preferably breakfast; capsules must be swallowed whole (do not open, chew, or crush). Note: Antacids may be administered with omeprazole. Adverse effects CNS:Headache, dizziness, fatigue. GI:Diarrhea, abdominal pain, nausea, mild transient increases in liver function tests. Urogenital:Hematuria, proteinuria. Skin:Rash.

Nursing implications Assessment & Drug Effects Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests with prolonged use. Patient & Family Education Report any changes in urinary elimination such as pain or discomfort associated with urination, or blood in urine. Report severe diarrhea; drug may need to be discontinued. Do not breast feed while taking this drug.

isosorbide mononitrate
Classification: Imdur is in a group of drugs called nitrates. Isosorbide mononitrate dilates (widens) bloodvessels, making it easier for blood to flow through them and easier for the heart to pump.Imdur is used toprevent angina attacks (chest pain).Imdur will not treat an angina attack that has already begun. Mechanism of Action: The Imdur product is an oral extended-release formulation of ISMN, the major activemetabolite of isosorbide dinitrate; most of the clinical activity of the dinitrate is attributable to the mononitrate.The principal pharmacological action of ISMN and all organic nitrates in general is relaxation of vascular smoothmuscle, producing dilatation of peripheral arteries and veins, especially the latter. Dilatation of the veinspromotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure and pulmonary capillary wedge pressure (preload). Arteriolar relaxation reduces systemicvascular resistance, and systolic arterial pressure and mean arterial pressure (afterload). Dilatation of thecoronary arteries also occurs. The relative importance of preload reduction, afterload reduction, and coronarydilatation remains undefined.

Indications and Usage for Imdur: Imdur Tablets are indicated for the prevention of angina pectoris due tocoronary artery disease. The onset of action of oral isosorbide mononitrate is not sufficiently rapid for thisproduct to be useful in aborting an acute anginal episode Contraindications: Imdur Tablets are contraindicated in patients who have shown hypersensitivity or idiosyncratic reactions to other nitrates or nitrites. Autonomic Nervous System Disorders: dry mouth, hot flushes.Body as a Whole: asthenia, back pain, chest pain, edema, fatigue, fever, flu-like symptoms, malaise, rigors. Cardiovascular Disorders, General: cardiac failure, hypertension, hypotension.Central and Peripheral Nervous System Disorders: dizziness, headache, hypoesthesia, migraine, neuritis,paresis, paresthesia, ptosis, tremor, vertigo Gastrointestinal System Disorders: abdominal pain, constipation, diarrhea, dyspepsia, flatulence, gastric ulcer,gastritis, glossitis, hemorrhagic gastric ulcer, hemorrhoids, loose stools, melena, nausea, vomiting. Hearing and Vestibular Disorders: earache, tinnitus, tympanic membrane perforation. Heart Rate and Rhythm Disorders: arrhythmia, arrhythmia atrial, atrial fibrillation, bradycardia, bundle branchblock, extrasystole, palpitation, tachycardia, ventricular tachycardia .Liver and Biliary System Disorders: SGOT increase, SGPT increase.Metabolic and Nutritional Disorders: hyperuricemia, hypokalemia. Musculoskeletal System Disorders: arthralgia, frozen shoulder, muscle weakness, musculoskeletal pain,myalgia, myositis, tendon disorder, torticollis.Myo-, Endo-, Pericardial, and Valve Disorders: angina pectoris a