Professional Documents
Culture Documents
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
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
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
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
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
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.
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
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.
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
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.