DRUG STUDIES

DRUG NAME Generic Name: Imipenem Brand Name: Primaxin Drug Classification: Anti-infectives Route: IVPB Available form: Powder for injection 500mg Q 6hour

ACTION Imipenem Bactericidal {01} {04} {05} {10} {15} {16} {22} {31}; binds to penicillinbinding proteins (PBP) 1A, 1B, 2, 4, 5, and 6 of E. coli {01} {03} {04} {05} {08} {10} {16} {27} and to PBP 1A, 1B, 2, 4, and 5 of Ps. aeruginosa {01} {04} {05} {08} {10} {16} {27}., CilastatinA competitive, reversible, highly specific inhibitor of the renal dipeptidase, dehydropeptidase I (DHP I) {01} {09} {10} {12} {17} {18} {20}

INDICATION Treatment of lower respiratory infections, Urinary tract Infection, Abdominal infections, Gynecologic infections, skin structure infections and bone and joint infection.

ADVERSE REACTION seizures, dizziness, somnolence, hypotension, colitis, nausea, vomiting, rash pruritus, sweating, urticaria, phlebitis at IV site; anaphylaxic, fever, super infection.

CONTRAINDICATIONS Cross-sensitivity may occur with infections, Abdominal infections penicillins and cephalosporins. Use cautiously in seizure disorders, geriatric Gynecologic infections patients; renal impairment, pregnancy, lactation, or children .

NURSING RESPONSIBILITIES

Observe patients

receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. Monitor BP during periods of diuresis and through period of dosage adjustment. Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician. Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter. Monitor for S&S of

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{22} {23} {24} {29} {31} {32}

hypokalemia (see Appendix F). Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions. Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia. Note: Excessive dehydration is most likely to occur in older adults, those with chronic cardiac disease on prolonged salt restriction, or those receiving sympatholytic agents

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DRUG NAME

ACTION

INDICATION

ADVERSE REACTION CNS: Seizures, dizziness, H/A GI: abdominal pain, anorexia, N/V, diarrhea Derm: rashes Hemat: leukopenia Neuro: peripheral neuropathy

CONTRAINDICATIONS

NURSING RESPONSIBILITIE S
Discontinue therapy immediately if symptoms of CNS toxicity (see Appendix F) develop. Monitor especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities). Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a second course is necessary. Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of CHF. Monitor patients on lithium for elevated lithium levels. Report appearance of candidiasis or its becoming more

Generic Name: Disrupts Metronidazole DNA and protein Brand Name: synthesis in Flagyl susceptible organisms. Bactericidal Drug Classification: Anti- Infective Route: IV Available form: Tablet or solution for IV 500 mg Q 8 hr

May be used for intra-abdominal infections; perioperative prophylactic agent in colorectal surgery

Hypersensitivity to metronidazole or other nitroimidazole derivatives.

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prominent with therapy to physician promptly. Repeat feces examinations, usually up to 3 mo, to ensure that amebae have been eliminated

DRUG NAME

ACTION

INDICATION

ADVERSE REACTION Nausea, Vomiting, Stomach pain, Heartburn, Diarrhea, Feeling an urgent need to urinate, Headache, Hives, Difficulty breathing or swallowing, Hoarseness or throat tightness, Rapid, irregular, or pounding heartbeat, Fainting, Fever

CONTRAINDICATIONS

Generic Name: Ciprofloxacin Brand Name: Quinosyn Drug Classification: Antibacterial Route: PO Available Form:

Inhibition of topoisomeras e(DNA gyrase)enzym es, which inhibits relaxation of supercoiled DNA and promotes breakage of double stranded DNA

Ciprofloxacin is used to treat infections of the skin, lungs, airways, bones, and joints caused by susceptible bacteria. Ciprofloxacin is also frequently used to treat urinary infections caused by bacteria such as E. coli. Ciprofloxacin is effective in

Contraindicated in persons with a history of hypersensitivity to ciprofloxacin, any member of the quinolone class of antimicrobial agents, or any of the product components.

NURSING RESPONSIBILIT IES Instruct patient not to take ciprofloxacin with dairy products such as milk or yogurt, or with calciumfortified juice. may eat or drink dairy products or calcium-fortified juice with a regular meal, but do not use them alone when

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Tablet 500-750mg Q12

treating infectious diarrhea caused by E. coli, Campylobacterjejun i, and Shigella bacteria.

taking ciprofloxacin. They could make the medication less effective. In form that Ciprofloxacin may cause swelling or tearing of a tendon(the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. may be more likely to occur if you are over 60, if you take an oral steroid medication, or if you have had kidney, heart, or lung transplant

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DRUG NAME

ACTION

INDICATION

ADVERSE REACTION CNS: headache, lethargy, numbness, paresthesia, peripheral neuropathy, neurotoxicity, seizures, twitching. EENT: ototoxicity GU: nephrotoxicity Hematologic: agranulocytosis, leucopenia, thrombo cytopenia Other: hypersensitivity reactions

CONTRAINDICATIONS

NURSING RESPONSIBILITI ES Assess patients infection and hearing before starting therapy and regularly thereafter. Obtain specimen for culture and sensitivity tests before giving the first dose. weight patient and review baseline renal function studies before therapy and regularly during therapy therapy usually continues for 7 to10 days. If no response occurs in3 to 5 days, therapy maybe stopped

Generic Name: Gentamicin sulfate Brand Name: Garamycin Drug Classification: Aminoglycosi de; antibiotic Route: PO 50mg/tab Avail. Form: IV infusion premixed, 100mg

Blocks betaadrenergic receptors of the sympathetic nervous system in the heart and juxtaglomerular apparatus (kidney), thus decreasing the excitability of the heart, decreasing cardiac output and oxygen consumption, decreasing the release of rennin from the kidney, and lowering BP.

Serious infection caused by sensitive strains of Pseudomonas aeruginosa, Escherichia coli,Proteus,Klebsie lla,Serratia,Eneterob acter,Citrobacter,Sta phylococcus.M.O.A Chemical effect: Inhibits protein synthesis by binding to ribosomes. Therapeutic effect: Kills susceptible bacteria (many aerobic gramnegative organisms and some aerobic gram-positive organisms). Drug may act against some aminoglycosideresistant bacteria.

Contraindicated with sinus bradycardia, second- or thirddegree heart block, cardiogenic shock, CHF, Pregnancy

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DRUG NAME Generic Name: digoxin Brand Name: Lanoxin Drug Classification: Cardiac Glycoside Route: Oral Available form: Tablet OD

ACTION Increases the force and velocity of myocardial contraction by increasing the refractory period of the AV node and increasing total peripheral resistance.

INDICATION CHF including that due to venous congestion, edema, dysnea, orthopnea and cardiac arrhythmia; control of rapid ventricular contraction rate in clients with atrial fibrillation or flutter; slow heart rate in sinus tachycardia due to CHF; SVT

ADVERSE REACTION Death; acute hemorrhage; convulsion; angioneurotic edema

CONTRAINDICATIONS Ventricular Fibrillation or tachycardia in presence of digoxin toxicity, hypersensitivity to cardiac glycosides, beri-beri disease, certain cases of hypersensitivity carotid sinus syndrome

NURSING RESPONSIBILITIES Obtain written parameters for high/ low pulse rate at which cardiac glycoside due to be held; changes in rhythm may indicate toxicity Monitor CBC, electrolytes, Ca, Mg, BNP, renal and LFTS. Reduce dose with renal dysfunction Obtain ECG, not rhythm/rate check apical pulse for 1 full minute before

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administering Observe for dysrrhytmias Monitor for weight and I&O; check for edema. Adequate intake will help prevent cumulative toxic drug effects. If gastric distress experience use antacid. Advice to take after meals to take lessens gastric irritation. Do not with grape fruit juice DRUG NAME Generic Name: Ferrous Sulfate Brand Name: Ferrovit Drug Classification: Antianemics ACTION Elevates the serum iron concentration which then helps to form High or trapped in the reticuloendothelial cells for storage and eventual conversion to a usable form of INDICATION Prevention and treatment of iron deficiency anemias. Dietary supplement for iron. ADVERSE REACTION Dizziness N&V Nasal Congestion Dyspnea Hypotension CHF MI Muscle cramps Flushing CONTRAINDICATIONS Hypersensitivity Severe hypotension Hemochromatosis and hemosiderosis Patients with preniscious anemia NURSING RESPONSIBILITIES Advise patient to take medicine as prescribed. Caution patient to make position changes slowly to minimize orhtostatic hypotension. Instruct patient to avoid concurrent use

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iron. Route: Oral Available form: Tablet PO

of alcohol or OTC medicine without consulting the physician. Advise patient to consult physician if irregular heartbeat, dyspnea, swelling of hands and feet and hypotension occurs. Inform patient that angina attacks may occur 30 min. after administration due reflex tachycardia. Encourage patient to comply with additional intervention for hypertension like proper diet, regular exercise, lifestyle changes and stress management INDICATION For prophylaxis of angina pectoris due to coronary ADVERSE REACTION Flushing, vascular headache, transient episode of dizziness CONTRAINDICATIONS Contra-indicated in patients hypersensitive to isosorbide dinitrate. NURSING RESPONSIBILITIES Inform or educate patient not to

DRUG NAME Generic Name: Isordil

ACTION ISORDIL is a dilator of arterial and

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Drug Classification: Anti-anginal drug Route: Oral Available form: Tablet 5mg/tab Prn

venous smooth muscle. It relaxes smooth muscle including vascular muscle, lowers peripheral arterial blood pressure, decreases venous return and decreases left ventricular filling pressure.

artery disease. The oral tablets are not indicated for the treatment of acute anginal attack, since the onset of this product is not sufficiently rapid to abort acute attack.

and weakness, cerebral ischemia associated with postural hypotension, nausea, vomiting, weakness, restlessness, pallor, perspiration and collapse; drug rash and /or/ exfoliative dermatitis

ISORDIL should not be used in patients with severe anaemia, recent head trauma or cerebral haemorrhage, severe renal or hepatic impairment, or in patients with increased intracranial pressure. Safety in pregnancy and lactation has not been established. Safety and effectiveness in paediatric patients have not been establised

chew crush sublingual or sustained release dosage form Do not change brands without consulting the physician or pharmacist, keep tablets or capsules in original container tightly closed. 8 to 12 hour nitrate free interval is needed each day to prevent tolerance NURSING RESPONSIBILITIES Assess for symptoms of stroke, MI during Treatment Monitor liver function studies: AST, ALT,bilirubin, creatinine if patient is on long-term

DRUG NAME Generic Name: Clopidogrel Brand Name: Plavix Drug Classification: antiplatelet agent

ACTION Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets

INDICATION Treatment of patients at risk for ischemic events history of MI, ischemic stroke, peripheral artery disease Treatment of patients with

ADVERSE REACTION CNS:Headache, dizziness,weakness, syncope, flushing

CONTRAINDICATIONS

Contraindicated with allergy to clopidogrel, active pathological bleeding such as peptic CV: Hypertension, ulcer or edema intracranial hemorrhage, Dermatologic:Ras h, lactation pruritus GI: Nausea, GI distress,

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Pregnancy Risk Category: C Route: Oral Available form: Tablet 75mg OD

acute coronary syndrome

constipation, diarrhea, GI bleed Other:Increased bleeding risk

therapy Monitor blood studies: CBC,Hgb, Hct, protime,cholesterol if the patient is on long-term therapy; thrombocytopeni a andneutropenia may occur. Precautions: bleeding disorders, recent surgery, hepatic impairment, pregnancy

DRUG NAME Generic Name: Clonazepam Brand Name: Rivotril Drug Classification: Anticonvulsant,

ACTION Probably facilitates the effects of the inhibitory neurotransmitt er GABA.

INDICATION Lennox- Gaustat syndrome, atypical absence seizures, akinetic and mycolonic seizures. Panic disorder

ADVERSE REACTION Fatigue, somnolence, muscular hypotonia, coordination disturbances, salivary or brochial hyper secretion; aggressiveness, irritability or

CONTRAINDICATIONS Use cautiously in patients with mixed type seizures because drug may cause generalized tonicclonic seizures. Use cautiously in children and in patients with chronic

NURSING RESPONSIBILITIES Use clonazepam cautiously in patients with renal failure, mixed seizure disorder (because drug can increase the risk of generalized tonic-clonic seizures), or respiratory

DRUG STUDIES

liver enzyme inducer Route: Oral Available form: Tablet 2mg OD, HS prn x insomia

Acute manic episodes of bipolar disorder Adjunct treatment for schizophrenia Periodic leg movements during sleep Parkinsonian dysarthria

agitation. Muscle weakness, restlessness, confusion, disorientation, depression, paradoxical reaction, nervousness, hostility, anxiety, sleep disturbance, nightmares, vivid dreams.

respiratory disease or open-angle glaucoma. Contraindicated in patients hypersensitive to benzodiazepines and in those with significant hepatic.

disease and troublesome secretions (because clonazepam increases salivation) and in elderly patients (because theyre more sensitive to drugs CNS effects). Monitor blood drug level, CBC, and liver function test results during long-term or high-dose therapy, as ordered. WARNING Dont stop drug abruptly; expect to taper dosage gradually to avoid withdrawal symptoms and seizures. Monitor patient closely for evidence of suicidal thinking or behavior, especially when therapy starts or dosage changes. PATIENT TEACHING Tell patient to take drug exactly as prescribed.

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Explain that stopping abruptly can cause seizures and withdrawal symptoms. Advise patient to avoid alcohol and sleepinducing drugs during therapy. Instruct him to consult prescriber before taking any OTC drugs. Urge patient to carry medical identification of his seizure disorder and drug therapy. Warn patient about possible drowsiness. Instruct patient to report severe dizziness, persistent drowsiness, palpitations, difficulty urinating, seizure activity, and other disruptive adverse reactions. Suggest that parents monitor childs performance in school because clonazepam

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can cause drowsiness or inattentiveness. Urge caregivers to watch patient closely for evidence of suicidal tendencies, especially when therapy starts or dosage changes, and to report concerns to prescriber immediately. Urge female patient who becomes pregnant while taking clonazepam to enroll in the Antiepileptic Drug Pregnancy Registry by calling 1-888-2332334. Explain that the registry is studying the safety of antiepileptic drugs during pregnancy. DRUG NAME Generic Name: Trimetazidine Brand Name: ACTION Trimetazidine is a cellular acting anti-ischaemic agent. It has 3 INDICATION ADVERSE REACTION CONTRAINDICATIONS Pregnancy and lactation; hypersensitivity NURSING RESPONSIBILITIES Check for doctors order Monitor blood pressure and pulse

Angina pectoris & GI disturbances ischemia if (nausea and neurosensorial vomiting) tissues as in

DRUG STUDIES

Vestar Drug Classification: Anti- angina drug Route: Oral Available form: Tablet 35mg BID

main properties by which it acts as a cytoprotective agent. It inhibits the anaerobic glycolysis and fatty acid metabolism, thus allowing only aerobic glycolysis. This action helps to restore the energy balance in the cell. It inhibits acidosis and free radical accumulation in the cell. All these action help the cell to restore the normal ionic and metabolic balance. ACTION The Imdur

Menieres disease.

rate before and after givingthe meds. Notify prescribing signs of heart failure such as swelling of hands and feet or SOB. Advise patient of the sideeffects of the drug.

DRUG NAME Generic Name:

INDICATION Prophylactic

ADVERSE REACTION Headache,

CONTRAINDICATIONS Shock, Constrictive

NURSING RESPONSIBILITIES Check the doctors

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ISMN Brand Name: Imdur Drug Classification: Anti- anginal drug Route: Oral Available form: Tablet 60mg/tab

product is an oral extendedrelease formulation of ISMN, the major active metabolite of isosorbide dinitrate; most of the clinical activity of the dinitrate is attributable to the mononitrate.

treatment of angina pectoris

hypotension with dizziness and nausea. tachycardia

cardiomyopathy, pericarditis,

order Headache may be a marker for drug activity; do not try to avoid by altering treatment schedule; aspirin or acetaminophen may be used for relief Dissolve SL tablets under tongue; do not crush, chew, or swallow Do not crush chewable tablets before administering Avoid alcohol Make changes in position slowly to prevent fainting