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LATANOPROST (Xalatan)

Prostaglandin Agonist/Glaucoma Agent


Indications: open-angle glaucoma, ocular HTN, elevated IOP
Action: prostaglandin, IOP by outflow of aqueous humor
Pharmacokinetics:
Dosage/Route: ophthalmic
A: cornea O: 3-4 hr P: 8-12 hr Half life: 17 min?? 1 drop of 0.005% sln daily in the evening
Distribution: minimal systemic
Met: hydrolyzed in aqueous humor to active form
Elim: renal
Side Effects: local irritation, foreign body sensation, lash growth, brown pigment in iris
Contraindications: hypersensitivity, intraocular infection/inflammation, conjunctivitis
Interactions: form precipitation with thimerosal eye-drops
Nursing Considerations:
Withold/notify prescriber if acute intraocular inflammation (iritis or uveitis) or external eye
inflammation
Remove contacts, dont reinsert 15 min
ONLY 1 drop
Wait 5 min b/a other drops
2-8 C; protect from light

AMOXICILLIN (Moxatag, Novamoxin)

Aminopenicillin/Antibiotic/Antiulcer agent
Indications: ENT, lower resp, skin, GU infections; endocarditis prophylaxis; ulcer disease due to
H pylori, post-exposure inhalation anthrax prophylaxis; Unlabeled: Lyme disease children <8 yr.
Action: Action: Binds to bacterial cell wall, causing cell death.
Therapeutic Effects: Bactericidal action; spectrum broader than penicillins
Pharmacokinetics:
Dosage/Route: PO
250-500 mg q8 hr or 500-875 mg q12hr;
O: 30 m P: 1-2hr D: 8-12 hr Half life: 0.7-1.4 hr
Extended release (for Strep throat)775 mg
Absorp: duodenum. More resistant to avid
once daily for 10 days
inactivation that other penicillins
Dist: diffuses readily into most body tissues/fluids (*Doses in Pts with renal impairment)
M: 30% in liver E: 70% unchanged in urine
Side Effects: seizures (high doses), anaphylaxis, serum sickness, pseudomembranous colitis,
diarrhea, rash, nausea, vomiting, urticarial, blood dyscrasias, liver enzymes, superinfection
Contraindications: hypersensitivity to penicillins (cross-sensitivity to cephalosporins and other
beta-lactams); infectious mononucleosis; severe renal insufficiency)
Interactions: may effect of warfarin; may effects of OCP; risk of rash with allopurinol;
effects with tetracyclines and chloramphenicol; renal excretion and blood levels of
amoxicillin with probenecid (may be combined for this purpose), disulferam
Nursing Considerations:
Assessment: infection (Vital signs, appearance of wound, sputum, urine, and stool; WBC) at
beginning of and throughout therapy; get history of allergies/sensitivities to any penicillins or
cephalosporins; observe for SS of anaphylaxis; monitor bowel function (diarrhea, abdominal
cramps, fever and bloody stools may be sign of pseudomembranous colitismay begin weeks

after cessation of therapy)


Implementation: may be given with meals, capsules can be emptied and swallowed with liquids;
do not crush or break extended-release tablets; administer oral suspension stat after shaking;
discard of suspension after 10 days
Education: use barrier contraception; finish drug completely even if feeling better; advise to report
signs of superinfection (furry overgrowth on tongue, vaginal itching or discharge, loose or foulsmelling stools) and allergy; notify HCP stat if diarrhea, abdominal cramping, fever, or bloody
stools occur and not to treat with antidiarrheals
*Diagnosis: Risk for infection (ind, se), Noncompliance (edu)

OFLOXACIN (Floxin Otic)

Antibiotic/Fluroquinolone
Indications: otitis externa; chronic suppurative otitis media w/ perf tympanic membranes; otitis
media in peds w/ tubes
Action: inhibit bacterial DNA synthesis by inhibiting DNA gyrase; bactericidal.
Therapeutic: death of susceptible bacteria
Pharmacokinetics: absorption, minimal Dosage/Route: 0.3% sln; 10 gtt = 0.5 mL
Otitis externa:10 gtts in ear(s) qd x 7 d
Chronic suppurative otitis media w/ perforated
tympanic membranes:10 gtts bid x 14 d
Side Effects: ear itching or pain, change in taste, dizziness, serious: allergic reaction rash, hives,
swelling, hoarseness, difficulty swallowing or breathing
Contraindications: allergy to ofloxacin, to other quinolones, or product components
Interactions: none known
Nursing Considerations:
Warm by holding bottle in hand for 1-2 min ( dizziness from of cold solution)
Teach use of ear drops
Patient should lie with affected ear upward, before instilling drops. Maintain position for 5 min.
For Otitis Media: pump the tragus 4 times by pushing inward to facilitate penetration into middle
ear after instillation
Store container at room temp and protect from light
Loop Diuretic
FUROSEMIDE (Lasix)
Indications: dema r/t CHF, renal disease, hepatic impairment; acute pulm edema; HTN
Action: inhibits reabsorption of sodium and chloride from loop of Henle and distal renal tubule;
secretion of water, sodium, chloride, magnesium, potassium, calcium; effectiveness persists in
impaired renal function. Therapeutic Effect: diuresis mob. of excess fluid; BP
Pharmacokinetics:
Dosage/Route: IV/IM/PO
Edema: 20-80 mg/day as single dose;
O:30-60m P:1-2 hr D:6-8 hr
can be by 20-40 mg q6-8 hr until
Half life: 30-60m ( renal impairment)
Absorp: 60-67% after oral (in acute HF & renal failure) desired response obtained

Met: minimally by liver; some nonhep, some renal


Excretion: as unchanged drug

HTN: 40 mg bid ( dose of other


antihypertensives by 50%), adjust
dose based on rxn.
Side Effects: erythema multiforme, stevens-johnson syndrome, toxic epidermal necrolysis,
aplastic anemia, agranulocytosis; dehydration, water/electrolyte depletion metabolic alkalosis,
abdominal pain, pancreatitis, dizziness, hypotension *Geriatric = incr. fall risk
Contraindications: hypersensitivity; cross-sensitivity with thiazides and sulphonamides; Hepatic
coma or anuria; alcohol intolerance (some liquid products may contain alcohol)
Interactions: risk of hypotension (antihypertensives, nitrates, alcohol); risk of hypokalemia
(other diuretics, amphotericin B, stimulant laxatives, corticosteroids); hypokalemia may risk of
digoxin toxicity and risk of arrhythmia; lithium excretion; risk of ototoxicity with
aminoglycosides or cisplatin
Nursing Considerations:
Assessment: monitor BP and pulse before and during administration; allergy to sulphonamides;
assess fluid status (weight, I/O ratios, edema, lung sounds, skin turgor, mucous membranes, thirst,
dry mouth, lethargy, hypotention, oliguria); assess for skin rash freq. during therapy, discontinue
at first sign of rash; electrolyte depletion; oxotoxicity (w/ renal impairment or oxotoxic drugs)
Implementation: do not confuse Lasix with Lanoxin; last dose no later than 5 pm; may be taken
with food or milk, can be crushed; do not administer if discoloured
Teaching: change position slowly to minimize orthostatic hypotension (exercise in hot weather or
standing for long periods of time may OH); notify HCP if gain 3+ pounds in 1 day; advise to
contact HCP stat if rash, muscle weakness, cramps, nausea, dizziness, numbness, or tingling of
extremities; use sunscreen and protective clothing (photosensitivity rxn)
*Nursing Dx: Excess fluid volume (ind)/Deficient fluid volume (se)
*Outcomes: in edema, BP, abdominal girth and weight; urinary output

ALBUTEROL (Ventolin, Accuneb, Airomir)

Adrenergic/Bronchodilator
Indications: asthma, COPD, or other reversible obstructive airway diseases; prevent exerciseinduced bronchospasms
Action: binds to -andrenergic sympathomimetic bronchodilator;relaxes bronchial smooth muscle
Pharmacokinetics: O: 515 min P: 0.52 h D: 36 h Dosage/Route: Inhaler
Bronchospasms: 1-2 puff q4-6h;
Half-Life: 2.75 h.
Prevention of exercise-induced
Metabolism: In liver; may cross the placenta.
bronchospasm: 2 x 30 min prior
Elimination: 76% in urine
Side Effects: paradoxical bronchospasm (excessive use of inhaler.), nervousness, restlessness,
tremor, chest pain, tachycardia, palpitations, GI upset
Contraindications: albuterol or levalbuterol (adrenergic amines) hypersensitivity; congenital
long GT syndrome. Use of oral syrup in children < 2 yr. Use of inhalator in children < 4 yr

Interactions: effects w/ other sympathomimetics; CVA effects w/ TCA, inhaled anesthetics;


use w/ MAOI may lead to hypertensive crisis; stimulant effect w/ caffeine products; effects
with BBs; effectiveness of insulin, oral hypoglycemics, digoxin. Risk of hypokalemia
concurrent use of K+-losing diuretics hypokalemia risk of digoxin toxicity

Nursing Considerations:
Check pulse, BP, lung sounds before admin and during peak of med/ Note amount, colour and
character of sputum produced
Monitor pulmonary function tests before initiating therapy and during (ABGs, pulse oximetry, etc)
Monitor for S/Sxs of paradoxical bronchospasms (wheezing) and CNS stimulation;
Instruct on use of inhaler; shake well, allow min 1 minute between INH, prime before use by
releasing 4 test sprays into air away from face; rinse mouth after use
Caution not to exceed recommended dose-may cause adverse effects like paradoxical
bronchospasms or loss of effectiveness of med
Advise patient to use 1st if using other inhalation meds and allow 5 minutes before administering
other meds

DIGOXIN (Lanoxin, Toloxin)

Antiarrhythmic/Inotropic/Cardiac Glycoside

Indications: CHF, AF & A flutter (slows ventricular rate), Paroxysmal Atrial Tachycardia (PAT)
Action: increases to force of myocardial contraction. Prolongs refractory period of the AV node. Decreases conduction through the SA and AV nodes. Therapeutic Effects: increases
CO (positive inotropic effect) and slowing of the HR (negative chronotropic effect)
Pharmacokinetics: Absorption: 60-80% tab; 70-85% elixir; 80% IM Onset: 30120 min PO; 530 min IV; 30 min IM. Peak: 28 h PO; 14 h IV; 4-6 h IM. Duration: 24 days in
patient with normal renal function ( in renal impairment). Distribution: Widely distributed; crosses placenta and enters breast milk. Metabolism and Elimination: excreted almost
entirely unchanged by the kidneys;.Half-Life: 3648 h. ( in renal impairment).
Side Effects: arrhythmias, fatigue, bradycardia, anorexia, nausea, vomiting; weakness, blurred, yellow or green vision, ECG changes, AV block, SA block, diarrhea, thrombocytopenia,
electrolyte imbalances with acute digoxin toxicity
Contraindicated in: hypersensitivity; uncontrolled ventricular arrhythmias; AV block (in absence of pacemaker); idiopathic hypetrophic subaortic stenosis; constrictive pericarditis;
alcohol intolerance (elixir only)
Interactions:
Nursing considerations:
Assessment: History: allergy to digitalis preps, ventricular tachycardia, ventricular fibrillation, heart block, sick sinus syndrome, IHHS, acute MI, renal insufficiency, decreased K+,
decreased Mg2+, increased Ca2+, pregnancy, lactation; Physical: weight, orientation, affect, reflexes, vision; P, BP, baseline ECG, cardiac auscultation, peripheral pulses, peripheral
perfusion, edema; R, adventitious sounds; abdominal percussion, bowel sounds, liver evaluation; urinary output; electrolyte levels, LFTs, renal function tests
Interventions: monitor apical pulse for 1 minute before administering; hold dose if pulse < 60; retake pulse in 1 hr. If pulse remains < 60, hold drug and notify prescriber. Note any
change from baseline rhythm or rate; avoid giving with meals, will delay absorption; Lenoxicaps and Lenoxin very different dosage; have emergency equipment ready in case toxicity
develops: K+ salts, lidocaine, phenytoin, atropine, and cardiac monitor
Teaching: wear/carry medical alert tag when on this drug; take pulse

ALBUTEROL (Ventolin, Accuneb, Airomir)

Adrenergic/Bronchodilator

Indications: asthma, COPD, or other reversible obstructive airway diseases; prevent exercise-induced bronchospasms
Action: binds to -andrenergic sympathomimetic bronchodilator; relaxes bronchial smooth muscle
Pharmacokinetics: O: 515 min; P: 0.52 h; D: 36 h; Half-Life: 2.75 h.

Metabolism: In liver; may cross the placenta. Elimination: 76% in urine

Dosage/Route: tablet, extended release tablet, syrup, capsule for inh, solution of inh, actuation
Bronchospasms: 1-2 puff q4-6h; Prevention of exercise-induced bronchospasm: 2 x 30 min prior
Side Effects: paradoxical bronchospasm (excessive use of inh.), nervousness, restlessness, tremor, chest pain, tachycardia, palpitations, GI upset
Contraindications: albuterol or levalbuterol (adrenergic amines) hypersensitivity; congenital long GT syndrome. Use of oral syrup in children < 2 yr. Use of inhalator in children < 4
yr
Interactions: effects w/ other sympathomimetics; CVA effects w/ TCA, inhaled anesthetics; use w/ MAOI may lead to hypertensive crisis; stimulant effect w/ caffeine products;
effects with BBs; effectiveness of insulin, oral hypoglycemics, digoxin. Risk of hypokalemia concurrent use of K+-losing diuretics hypokalemia risk of digoxin toxicity
Nursing Considerations:
Check pulse, BP, lung sounds before admin and during peak of med/ Note amount, colour and character of sputum produced
Monitor pulmonary function tests before initiating therapy and during (ABGs, pulse oximetry, etc) Monitor for S/Sxs of paradoxical bronchospasms (wheezing) and CNS stimulation;
Instruct on use of inhaler; shake well, allow min 1 minute between INH, prime before use by releasing 4 test sprays into air away from face; rinse mouth after use
Caution not to exceed recommended dose-may cause adverse effects like paradoxical bronchospasms or loss of effectiveness of med
Advise patient to use 1st if using other inhalation meds and allow 5 minutes before administering other meds

FUROSEMIDE (Lasix)

Loop Diuretic

Indications: edema r/t CHF, renal disease, hepatic impairment; acute pulm edema; HTN
Action: inhibits reabsorption of sodium and chloride from loop of Henle and distal renal tubule; secretion of water, sodium, chloride, magnesium, potassium, calcium; effectiveness
persists in impaired renal function. Therapeutic Effect: diuresis mob. of excess fluid; BP
Pharmacokinetics: Absorp: 60-67% after oral (dcr.in acute HF & renal failure); Metabolism: minimally metabolized by liver, some nonhepatic metabolism, some renal Excretion: as
unchanged drug; Half life: 30-60 min (incr. in renal impairment); Time: PO: O-30-60 min/P 1-2 hr/ D 6-8 hr; IM: 10-30 min/P unknown/D 4-8 hr; IV: O 5 min/P 30 min/D 2 hr
Dosage/Routes: IV/IM/PO (sln & tabs)
Edema: PO - initially, 20-80 mg/day as single dose; can be increased by 20-40 mg q 6-8 hrs until desired diuretic response is obtained; IM/IV 20-40 mg, may repeat in 1-2 hr and
incr. by 20 mg every 1-2 hr until response is obtained, maintenance dose may given given q 6-12 hr. HTN: PO - 40 mg bid ( dose of other antihypertensives by 50%), adjust dose
based on rxn.
Side Effects: erythema multiforme, stevens-johnson syndrome, toxic epidermal necrolysis, aplastic anemia, agranulocytosis; dehydration, water/electrolyte depletion metabolic
alkalosis, abdominal pain, pancreatitis, dizziness, hypotension *Geriatric = incr. fall risk
Contraindications: hypersensitivity; cross-sensitivity with thiazides and sulphonamides; Hepatic coma or anuria; alcohol intolerance (some liquid products may contain alcohol)
Interactions: risk of hypotension (antihypertensives, nitrates, alcohol); risk of hypokalemia (other diuretics, amphotericin B, stimulant laxatives, corticosteroids); hypokalemia
may risk of digoxin toxicity and risk of arrhythmia; lithium excretion; risk of ototoxicity with aminoglycosides or cisplatin
Nursing Considerations:
Assessment: monitor BP and pulse before and during administration; allergy to sulphonamides; assess fluid status (weight, I/O ratios, edema, lung sounds, skin turgor, mucous
membranes, thirst, dry mouth, lethargy, hypotention, oliguria); assess for skin rash freq. during therapy, discontinue at first sign of rash; electrolyte depletion; oxotoxicity (w/ renal
impairment or oxotoxic drugs)
Implementation: do not confuse Lasix with Lanoxin; last dose no later than 5 pm; may be taken with food or milk, can be crushed; do not administer if discoloured
Teaching: change position slowly to minimize orthostatic hypotension (exercise in hot weather or standing for long periods of time may OH); notify HCP if gain 3+ pounds in 1 day;
advise to contact HCP stat if rash, muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities; use sunscreen and protective clothing (photosensitivity rxn)
*Nursing Dx: Excess fluid volume (ind)/Deficient fluid volume (se)
*Outcomes: in edema, BP, abdominal girth and weight; urinary output

ALBUTEROL (Ventolin, Accuneb, Airomir)

Adrenergic/Bronchodilator

Indications: asthma, COPD, or other reversible obstructive airway diseases; prevent exercise-induced bronchospasms
Action: binds to -andrenergic sympathomimetic bronchodilator; relaxes bronchial smooth muscle
Pharmacokinetics: O: 515 min; P: 0.52 h; D: 36 h; Half-Life: 2.75 h.

Metabolism: In liver; may cross the placenta. Elimination: 76% in urine

Dosage/Route: tablet, extended release tablet, syrup, capsule for inh, solution of inh, actuation
Bronchospasms: 1-2 puff q4-6h; Prevention of exercise-induced bronchospasm: 2 x 30 min prior
Side Effects: paradoxical bronchospasm (excessive use of inh.), nervousness, restlessness, tremor, chest pain, tachycardia, palpitations, GI upset
Contraindications: albuterol or levalbuterol (adrenergic amines) hypersensitivity; congenital long GT syndrome. Use of oral syrup in children < 2 yr. Use of inhalator in children < 4
yr
Interactions: effects w/ other sympathomimetics; CVA effects w/ TCA, inhaled anesthetics; use w/ MAOI may lead to hypertensive crisis; stimulant effect w/ caffeine products;
effects with BBs; effectiveness of insulin, oral hypoglycemics, digoxin. Risk of hypokalemia concurrent use of K+-losing diuretics hypokalemia risk of digoxin toxicity
Nursing Considerations:
Check pulse, BP, lung sounds before admin and during peak of med/ Note amount, colour and character of sputum produced
Monitor pulmonary function tests before initiating therapy and during (ABGs, pulse oximetry, etc) Monitor for S/Sxs of paradoxical bronchospasms (wheezing) and CNS stimulation;
Instruct on use of inhaler; shake well, allow min 1 minute between INH, prime before use by releasing 4 test sprays into air away from face; rinse mouth after use
Caution not to exceed recommended dose-may cause adverse effects like paradoxical bronchospasms or loss of effectiveness of med
Advise patient to use 1st if using other inhalation meds and allow 5 minutes before administering other meds

DIGOXIN (Lanoxin, Toloxin)

Antiarrhythmic/Inotropic/Cardiac Glycoside

Indications: CHF, AF & A flutter (slows ventricular rate), Paroxysmal Atrial Tachycardia (PAT)
Action: increases to force of myocardial contraction. Prolongs refractory period of the AV node. Decreases conduction through the SA and AV nodes. Therapeutic Effects: increases
CO (positive inotropic effect) and slowing of the HR (negative chronotropic effect)
Pharmacokinetics: Absorption: 60-80% tab; 70-85% elixir; 80% IM Onset: 30120 min PO; 530 min IV; 30 min IM. Peak: 28 h PO; 14 h IV; 4-6 h IM. Duration: 24 days in
patient with normal renal function ( in renal impairment). Distribution: Widely distributed; crosses placenta and enters breast milk. Metabolism and Elimination: excreted almost
entirely unchanged by the kidneys;.Half-Life: 3648 h. ( in renal impairment).
Side Effects: arrhythmias, fatigue, bradycardia, anorexia, nausea, vomiting; weakness, blurred, yellow or green vision, ECG changes, AV block, SA block, diarrhea, thrombocytopenia,
electrolyte imbalances with acute digoxin toxicity

Contraindicated in: hypersensitivity; uncontrolled ventricular arrhythmias; AV block (in absence of pacemaker); idiopathic hypetrophic subaortic stenosis; constrictive pericarditis;
alcohol intolerance (elixir only)
Interactions:
Nursing considerations:
Assessment: History: allergy to digitalis preps, ventricular tachycardia, ventricular fibrillation, heart block, sick sinus syndrome, IHHS, acute MI, renal insufficiency, decreased K+,
decreased Mg2+, increased Ca2+, pregnancy, lactation; Physical: weight, orientation, affect, reflexes, vision; P, BP, baseline ECG, cardiac auscultation, peripheral pulses, peripheral
perfusion, edema; R, adventitious sounds; abdominal percussion, bowel sounds, liver evaluation; urinary output; electrolyte levels, LFTs, renal function tests
Interventions: monitor apical pulse for 1 minute before administering; hold dose if pulse < 60; retake pulse in 1 hr. If pulse remains < 60, hold drug and notify prescriber. Note any
change from baseline rhythm or rate; avoid giving with meals, will delay absorption; Lenoxicaps and Lenoxin very different dosage; have emergency equipment ready in case toxicity
develops: K+ salts, lidocaine, phenytoin, atropine, and cardiac monitor
Teaching: wear/carry medical alert tag when on this drug; take pulse
NITROGLYCERINE (Nitro-Dur)
Contraindications: hypersensitivity to drug; hypersensitivity to adhesives; hypotension, orthostatic; severe anemia; cerebral haemorrhage
Adverse Effects: severe hypotension; common: heache, nausea, vomiting, tachycardia, diarrhea, palpitations, dyspnea, contact dermatitis, dysuria
Interactions: Use with sildenafil, avanafil, tadalafil, vardenafil, riociguat risk of serious and potentially fatal hypotension, syncope or MI; Additive hypotension with
antihypertensives, acute ingestion of alcohol, BBs, CCBs, haloperidol, or phenothiazines. Anticholinergic properties (TCAs, antihistamines, phenothiazines) may absorp of
translingual or sublingual

Action: incr. coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions; resulting in relaxation of vascular smooth muscle
Pharmacokinetics: Excretion: urine; Half-life 1-4 min, 40 min (metabolites); Info: plasma conc. Declines w/ half-life of 1h after patch removal; Metabolism: liver, erythrocytes,
vascular walls
Onset: 40-60 min Peak: unknown Duration: 8-24 hr
Pharmacokinetics (Medscape)
- half-life 12-33 min
- onset 60 min
- duration 10-12 hr
- bio avail 75%
- protein bound 60%
- metabolism mainly in liver, extrahepatic sites: vascular wall, RBC
- excretion: urine
- clearance: 5.5-11 L
- dialyzable: no

Idiopathic hypertrophic subaortic stenosis: Obstruction of the flow of blood out of the left
ventricle due to hypertrophy of the ventricular septum.

Amoxicillin oral suspension 250 mg po BID


Digoxin 0.25 mg PO once daily (hold if pulse is below 60)
Latanoprost 0.005% eye drops 1 drop to right eye once daily
Nitro patch 0.4 mg/hr (on at 0800 remove at 2000)
Ofloxacin ear drop 1 drop to left ear bid
Ventolin 2 puffs QID
Lasix 40 mg PO BID