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: 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
A: duodenum. More resistant to avid inactivation
once daily for 10 days
that other penicillins
(*Doses in Pts with renal impairment)
D: diffuses readily into most body tissues/fluids
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

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:
Dosage/Route: PO
Edema: 20-80 mg/day can be 20-40 mg
O: 30-60 m P: 1-2hr D: 6-8 hr Half-life: 30-60 m
q6-8h until desired response
A: 60-67% oral (acute HF & renal failure)
HTN: 40mg bid( dose of other antiHTN by
M: minimally by liver; some renal
50%)
E: unchanged
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



AMOXICILLIN (Moxatag, Novamoxin)

Aminopenicillin/Antibiotic/Antiulcer Agent

Nursing Considerations:
Assessment:
History of allergies/sensitivities to any penicillin or cephalosporins;
Infection at beginning of and throughout therapy (VS, appearance of wound, sputum, urine,
stool; WBC)
Monitor bowel function
Implementation:
May take with meals;
Administer oral suspension stat after shaking;
Do not crush or break extended-release tablets;
Caps can be emptied and swallowed with liquids
Education:
Use barrier contraception;
Finish drug completely even if feeling better; a
Advise to report signs of superinfection (furry overgrowth on tongue, vaginal itching or
discharge, loose stool);
Notify HCP stat if diarrhea, cramps, fever, blood stool occur and not to treat with antidiarrheals

FUROSEMIDE (Lasix)

Loop Diuretic

Nursing Considerations:
Assessment:
BP and pulse before administration
Fluid status (weight, I/O, edema, lung sounds, skin turgor, thirst, lethargy, hypoTN, oliguria)
Allergy to sulphonamides
Ototoxicity (w/ renal impairment or ototoxic drugs)
Assess for skin rash freq. during therapy, discontinue at first sign of rash
Electrolyte depletion
Implementation:
Do not confuse Lasix with Lanoxin
Last dose no later than 5pm
Can be taken with food or milk, can be crushed
Teaching:
Change position slowly to minimize orthostatic hypotension
Notify HCP if gain 3+ lbs. 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)



ALBUTEROL (Ventolin, Accuneb, Airomir)

Adrenergic/Bronchodilator
Indications: asthma, COPD, or other reversible obstructive airway diseases; prevent exerciseinduced bronchospasms
Action: binds to -adrenergic sympathomimetic bronchodilat.; relaxes bronchial smooth muscle
Pharmacokinetics:
O: 5-15 m P: 0.5-2 hr D: 3-6 hr Half-life: 2.75 hr
A: resp tract M: liver E: 76% in urine in 3 days

Dosage/Route: INH
Bronchospasms: 1-2 inh q4-6h
Prev. of ex-induced: 2 inh 30min 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 sympathomimetic; CVA effects w/ TCA, inhaled anaesthetics;
use w/ MAOI may lead to hypertensive crisis; stimulant effect w/ caffeine products; effects
with BBs; effectiveness of insulin, oral hypoglycaemic, digoxin. Risk of hypokalemia
concurrent use of K+-losing diuretics hypokalemia risk of digoxin toxicity

NITROGLYCERINE (Nitro-Dur)

Coronary Vasodilator/Antianginal/Nitrate
Indications: long-term prophylactic management of angina pectoris
Action: incr. coronary blood flow by dilating coronary arteries and improving collateral flow to
ischemic regions; resulting in relaxation of vascular smooth muscle (relaxes BV increases
oxygen and blood flow to heart
Pharmacokinetics:
Dosage/Route: Transdermal patch
Apply new patch daily, remove after 12-14
O: 60 m D: 10-24 hr Half-life: 12-33 m
hr to prevent tolerance
M: liver, vascular walls, RBC E: urine
0.1 mg/h, 0.2 mg/h, 0.3 mg/h, 0.4 mg/h,
*plasma concentration declines w/ half-life of 1hr
0.6 mg/h, 0.8 mg/h
after patch removal
Side Effects: severe hypotension, orthostatic hypotension, headache, nausea, vomiting,
tachycardia, diarrhea, palpitations, dizziness, dyspnea, contact dermatitis, dysuria
Contraindications: hypersensitivity to drug; hypersensitivity to adhesives; hypotension,
orthostatic; severe anemia; cerebral haemorrhage
Interactions: 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



ALBUTEROL (Ventolin, Accuneb, Airomir)

Adrenergic/Bronchodilator

Nursing Considerations:
Assessment:
Pulse, BP, lung sounds before admin and during peak; Note amt, colour and quality of sputum
Monitor pulmonary function tests before initiating therapy and during (ABGs, pulse oximetry,
etc)
Monitor for S/Sxs of paradoxical bronchospasm and CNS stimulation
Teaching:
Instruct on how to self-administer (shake 2-5 sec [5-6 shake], 2 ways to position, deep breath,
breath 3-5 sec, hold breath for 10 sec; after 2 min of last dose, rinse mouth
Caution not to exceed recommended dose-may cause adverse effects (paradoxical
bronchospasm) or loss of effectiveness
Advise patient to use 1st if using other inhalation meds and allow 5 min between

NITROGLYCERINE (Nitro-Dur)

Coronary Vasodilator/Antianginal/Nitrate

Nursing Considerations:
Assessment:
Take baseline BP and HR with patient in sitting position before initiation of tx with patch; check
again with patient in a sitting position 1 hour later
Postural hypotension; supervise ambulation especially in elderly and debilitated patient; patient
may complain of dizziness or weakness due to postural hypotension
Topical reactions (contact dermatitis from the patch)
Implementation:
Apply at same time each day, ensure site is free of hair and not subject to excessive movement.
Avoid irritated, abraded, or scarred skin
Change application site each time to prevent skin irritation and sensitization
Apply firm pressure over patch to ensure contact with skin
Education:
Units are waterproof and not affected by showering or bathing
Change positions slowly to minimize orthostatic hypotension
Advise patient to avoid using alcohol at same time
Inform patient that headache is a common side effect that should decrease with continuing
therapynotify HCP if it is persistent or severe
Advise to notify HCP if dry mouth or blurred vision occurs



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: CO (+tive inotropic effect) / slowing of the HR (-tive chronotropic effect)
Pharmacokinetics:
Dosage/Route: PO
O: 30-120 m P: 2-8 h D: 24 d ( in renal impair.) -0.75-1.5 mg given as 50% of the dose
initially and one quarter of the initial dose in
Half-life: 36-48 h ( in renal impair.) A: 60-80%
each of 2 subsequent doses at 6-12 hr
D: widely M: liver E: unchanged by kidney
intervals; Maintenance: 0.125-0.5 mg/day
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
Contraindications: hypersensitivity; uncontrolled ventricular arrhythmias; AV block (in absence
of pacemaker); idiopathic hypertrophic subaortic stenosis; constrictive pericarditis; alcohol
intolerance (elixir only)
Interactions: tox: azole antifung., macrolides, tetracyclines, ritonavir; hypercal, hypermag,
tox: thiazides, parenteral Ca+; hypokal, tox: diuretics, amphotericin B, carbenicillin, ticarcillin,
corticosteroids; levels: propantheline, quinidine, verapamil, amiodaron, anti-cholinergics,
diltiazem, nifedipine, indomethacin; bradycardia: blockers, antidysrythmics; dysrhythmia
risk: sympathomimetic; absoption:antacids, kaolin/pectin, cholestyramine, metoclopramide;
level: thyroid agents, cholestyramine, colestipol, metoclopramide, amiloride; liquorice, fibre



DIGOXIN (Lanoxin, Toloxin)

Antiarrhythmic/Inotropic/Cardiac Glycoside

Nursing Implications:
Assessment:
Take apical pulse for 1 full min, noting rate, rhythm, and quality before admin drug (Withhold if
pulse is below 60)
Monitor for S/Sx of toxicity: anorexia, nausea, vomiting, diarrhea, visual disturbances
Monitor I/O ratio, particularly in patients with impaired renal function; also monitor for edema
Implementation:
Do not confuse Lanoxin with levothyroxine or naloxone
Digoxin has a narrow therapeutic rangehave a second HCP independently check original
order and dose calculations. Monitor drug levels
Teaching:
Report if pulse falls below 60 or rises above 110 or if you detect skipped beats or other changes
in rhythm
Report if any of the following occur, may be toxicity: anorexia, vomiting, nausea, diarrhea, or
visual disturbances
Take digoxin precisely as prescribed at the same time each day, do not skip or double a dose or
change dose intervals
Do not take OTC meds, especially those for coughs, colds, allergy, GI upset or obesity without
approval



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: 3 hr
1 drop of 0.005% sln daily in the
Distribution: minimal systemic
evening
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:
Withhold/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

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)
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