NURS 1566 Clinical Form 3: Clinical Medications Worksheets

(You will need to make additional copies of these forms)

Generic Name Trade Name Classification Dose Route Time/frequency

levofloxacin Factive Anti-infectives 750 mg in 150 IVPB Infuse over 90 min q 24
mL D5W hrs
Peak Onset Duration Normal dosage range
End of infusion Rapid 24 hrs 250-750 mg q 24 hr
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or
Prophylactic against infection of necrotic pancreatic solutions
tissue Dilute to a concentration of 5 mg/ml with 0.9% NaCl,
D5W, D5/0.9% NaCl, D5/0.45% NaCl, D5/LR, 5% sodium
bicarbonate, D5, Plasmalyte 56, or sodium lactate. Also
available in premixed bottles and flexible containers with
D5W, which need no further dilution. Discard unused
solution. Diluted solution is stable for 72 hr at room
temperature and 14 days if refrigerated. Rate: Administer
by infusion over at least 60 min for 250 mg or 500 mg
doses and over 90 min for 750 mg dose. Avoid rapid bolus
injection to prevent hypotension.
Y-Site Compatibility: amikacin, aminophylline, ampicillin,
bivalirudin, caffeine citrate, cefotaxime, cimetidine,
clindamycin, dexamethasone, dexmedetomidate,
dobutamine, dopamine, epinephrine, fenoldopam, fentanyl,
gentamicin, isoproterenol, lidocaine, linezolid, lorazepam,
metoclopramide, morphine, oxacillin, pancuronium,
penicillin G, phenobarbital, phenylephrine, sodium
bicarbonate, vancomycin.
Y-Site Incompatibility: acyclovir, alprostadil, azithromycin,
furosemide, heparin, indomethacin, nitroglycerin,
nitroprusside, propofol.
Additivie Compatibility: potassium chloride.
Mechanism of action and indications
(Why med ordered)
Inhibit bacterial DNA synthesis by inhibiting DNA
gyrase. Results in the death of susceptible bacteria.
Nursing Implications (what to focus on)
Contraindications/warnings/interactions
Hypersensitivity. Cross-sensitivity among agents may
occur (including cinoxacin and nalidixic acid).
Use cautiously in: Underlying CNS pathology, Renal
impairment (dosage reduction if CCr <50 ml/min for
ciprofloxacin, levofloxacin, ofloxacin, sparfloxacin; <30
ml/min for norfloxacin; <40 ml/min for gatifloxacin,
gemifloxacin or lomefloxacin), cirrhosis.
Common side effects
dizziness, drowsiness, headache, insomnia, abdominal
pain, diarrhea, nausea, SEIZURES, ARRHYTHMIAS,
PSEUDOMEMBRANOUS COLITIS,
HYPERSENSITIVITY REACTIONS INCLUDING
ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME
Interactions with other patient drugs, OTC or
herbal medicines (ask patient specifically)
None for this patient
Lab value alterations caused by medicine
Fluoroquinolones may cause ↑ serum AST, ALT, LDH,
bilirubin, and alkaline phosphatase, May also cause ↓
WBC; ↑ or ↓ serum glucose; and glucosuria, hematuria,
proteinuria, and albuminuria
Be sure to teach the patient the following about this
medication
Instruct patient to take medication as directed at evenly
spaced times and to finish drug completely, even if feeling
better. Take missed doses as soon as possible, unless almost
time for next dose. Do not double doses. Advise patient
that sharing of this medication may be dangerous. Caution
patients that fluoroquinolones should only be used to treat
bacterial infections; they are not effective against viral
infections, such as the common cold. Encourage patient to
maintain a fluid intake of at least 1500-2000 ml/day to
prevent crystalluria. Advise patients to notify health care
professional immediately if they are taking theophylline.
Advise patient that antacids or medications containing iron
or zinc will decrease absorption and should not be taken
within 6 hr before lomefloxacin and 2 hr after taking this
medication. May cause dizziness and drowsiness. Caution
patient to avoid driving or other activities requiring
alertness until response to medication is known. Advise
patient to notify health care professional of any personal or
family history of QTc prolongation or proarrhythmic
conditions such as recent hypokalemia, significant
bradycardia, or recent myocardial ischemia. Patients with
this history should not receive fluoroquinolones. Caution
patient to use sunscreen and protective clothing to prevent
phototoxicity reactions during and for 5 days after therapy.
Notify health care professional if a sunburn-like reaction or
skin eruption occurs. Instruct patient to consult health care
professional before taking any other Rx, OTC, or herbal
products. Advise patient to report signs of superinfection
(furry overgrowth on the tongue, vaginal itching or
discharge, loose or foul-smelling stools). Instruct patient to
notify health care professional if fever and diarrhea
develop, especially if stool contains blood, pus, or mucus.
Advise patient not to treat diarrhea without consulting
health care professional. Instruct patient to notify health
care professional immediately if rash or tendon pain or
inflammation occur. Therapy should be discontinued.
Nursing Process- Assessment
(Pre-administration assessment)
Assess for infection (vital signs;
appearance of wound, sputum, urine, and
stool; WBC; urinalysis; frequency and
urgency of urination; cloudy or foul-
smelling urine) prior to and during
therapy.
Assessment Evaluation
Why would you hold or not give this Check after giving
med? Resolution of the signs and
Signs and symptoms of anaphylaxis symptoms of infection. Time
(rash, pruritus, laryngeal edema, for complete resolution
wheezing). Discontinue drug and depends on organism and
notify physician or other health care site of infection.
professional immediately if these
problems occur. Keep epinephrine, an
antihistamine, and resuscitation
equipment close by in case of an
anaphylactic reaction. Instruct patient
to notify health care professional
immediately if rash or tendon pain or
inflammation occur. Therapy should
be discontinued.