Nursing Drug Reference Weeks 10 and 11

• Aspirin
• Acetaminophen
• Ibuprofen
• Naproxen (Alieve)

• Controls pain
•  - Headaches
•  - Inflammation
•  - Abrasions
•  - Muscle aches
•  - Arthritis pain

• Aspirin
• Ibuprofen
• Naproxen

• Analgesic: Inhibits pain
• Antipyretic: Works on fevers
• Anti-inflammatory: Decreases inflammation
• Preventative measures against: TIA's, MI's or other thromboembolotic episodes

Children <12

• Inhibits the platelet aggregation (inhibits their ability to stick together)
• NOTE: Think of it like "slick 50" for your car - it makes them so slippery, they can't stick together

Inhibits cyclooxygenase (Cox 1 and Cox 2)

Gastric irritation, bleeding, and ulcers

• Protects the stomach lining: thus, when Aspirin inhibits this enzyme you get the gastric bleeding
• Promotes platelet aggregation: Helps clump platelets together, thus, Aspirin inhibits this and you get the "slick 50" effect

Cyclooxygenase (Cox 1 and Cox 2)

• Aspirin
• Ibuprofen

Gastric bleeding and ulcers can occur

• Inflammation and inflammatatory diseases: Gout
• Pain: osteo and rheumatoid arthritis

Celebrex

• Strokes
• MI's

Decreases pain and inflammation

Blocks Cox 2 enzyme

• A. Gastric bleeding
• B. Ulcers

True

False

True

False

• Relieves pain
• Helps with discomfort
• Brings down a fever

25% of all over the counter (OTC) drugs sold

Little to no gastric distress

False

Yes, too much is toxic to the liver cells

• Individuals with Renal or Liver disease
• Alcoholics

Liver labs: ALT, AST, and billirubin

• Computerized/locked medication systems
• "Pyxis" or med-cart system
• Locked
• Secured area
• Fingerprint and password access

A drug whose manufacture, possession, and use are regulated by the government

• Strict documentation
• Counted and monitored each shift
• Wasting must be witnessed by another licensed personnel

To indicate drugs with the potential for abuse

Schedule I - V

• No accepted medical use: High potential fo abuse
• Only exception is peyote use by Native Americans
• Example: Heroine

• Some medical uses: high potential for abuse
• Example: Oxycodone

• Medically accepted: may cause dependence
• Example: Tylenol III

• Medically accepted: may cause dependence
• Example: Ativan, Ambien, etc.

• Medically accepted: Very limited potential for dependence
• Example: Codeine cough syrup

• Codeine
• Demeraol (meperedine)
• Percocet/Percodan
• Fentanyl

Any member of the group of drugs used to relieve pain

• It is a drug that acts as an antidote to an opiod overdose
• Used to counteract opiod-induced respiratory depression

naloxone (Rx) Narcan

Administer only with resuscitative equipent and O₂ nearby

• Vital Signs (VS): Every 3-5 minutes
• Respirations: Character, rate, rhythm

Inhibits synaptic responses in the CNS: decreased neurotransmission,  decreased pain, and decreased spasticity or spasms

• Dizziness
• weakness
• Fatigue
• Drowsiness
• Headache

• Do not drink alcohol or take other CNS depressants
• Avoid hazardous activities while taking Somas
• Do not discontinue use quickly, must be tapered off

Sulfate

morphine (Rx)

Opiod analgesic

High Alert!

Alkaloid

Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors

Moderate to severe pain

• Hypersensitivity, addition (opioid), hemorrhage, bronchial asthma, increased intracranial pressure, paralytic ileus, hypovolemia, shock
• BLACK BOX WARNING: Respiratory depression - Do not give with other CNS depressive medications

• Pregnancy (C), breast feeding, children <18 yr, geriatric patients, addictive personality, acute MI, sever heart disease, renal/hepatic disease, bowel impaction
• BLACK BOX WARNING: Abrupt discontinuation, accidental exposure, epidural/introthecal administrtion, opioid-naive patients, substance abuse

• Common: NONE
• Life threatening: Seizures

• Common: NONE
• Life threatening: Bradycardia, shock, cardiac arrest, and tachycardia

• Common: NONE
• Life threatening: Thrombocytopenia

• Common: NONE
• Life threatening: Respiratory depression, respiratory arrest, apnea

• PO: Onset variable, peak variable, duration variable
• IM: Onset 1/2 hr, peak 50-90 min, duration 3-7hr
• SubQ: Onset 15-20 min, peak 50-90 min, duration 3-5hr
• IV: Peak 20 min
• RECT: Peak 1/2-1 hr, duration 4-5 hr
• Intrathecal: Onset rapid, duration equal to or <24 hr
• Metabolized: By liver
• Crosses: Placenta
• Excreted: in urine, breast milk;
• Half-life: 1 1/2 - 2 hr

• Pain: location, type, character; give dose before pain becomes severe
• Bowel status: constipation common, use stimulant laxative if needed
• I&O ratio: check for decreasing output, may indicate urinary retention
• B/P: pulse, respirations (character, depth, rate)
• CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction
• Alercgic reactions: rash, urticaria
• Respiratory dysfunction: depression, character, rate, rhythm; notfy prescriber if respirations are <12/min; accidental overdose has occurred with high-potency orals sols
• BLACK BOX WARNINGS
• Abrupt discontinuation: gradually taper to prevent withdrawal symptoms; decrease by 50% q 1-2 days; avoid use of narcotic antagonists
• Accidental exposure: if Duramorph or Infumorph gets on skin, remove contaminated clothing, rinse affected area with water

• Storage: In light-resistanct container at room temp
• Assistance: With ambulation
• Safety measures: side rails, night-light, call bell within easy reach
• Gradual withdrawal: After long-term use

• Therapeutic response
• Decrease in pain intensity

• To change position slowly; orthostatic hypotension may occur
• To report any symptoms of CNS changes, allergic reactions
• Physical dependency may result from long term use
• Avoid use of alcohol, CNS depressants
• Withdrawal symptoms may occur: nausea, vomiting, cramps, fecer, faintness, and anorexia

• Naloxone (Narcan) 0.2-0.8 mg IV
• O₂
• IV fluids
• Vasopressors

• 1. It is used to PREVENT a clot
• 2. It is used when a client HAS a clot
• 3. It is used when a client has HAD a clot

• Inactivation of Factors X: Prevents the conversion of prothrombin to thrombin
• Limits: Fibrin formation of stable clot
• Prolonged: Clotting time
• No effects: On blood clots already formed
• NOTE: It increases the clotting time

• Myocardial Infarction (MI) - A clot in the heart
• Stroke - A clot in the brain

• Competitive blocking of vitamin K: Prevents synthesis of Vitamin K in th liver
• Subsequent prevention of the actication of dependent clotting factors, including: Factor II (prothombin), Factor VII, Factor IX, and Factor X

• PTT, which is a test to find out if the right dose of heparin is being used.
• Clue: The two TT's can form an H!

NOTE: Partial thromboplastin time (PTT) and prothrombin time (PT/INR) are often done at the same time to check for bleeding problems or the chance for too much bleeding in surgery.

• Prothrombin time (PT) is a blood test that measures how long it takes blood to clot. A prothrombin time test can be used to check for bleeding problems. PT is also used to check whether medicine to prevent blood clots is working.
• A PT test may also be called an INR test. INR (international normalized ratio) stands for a way of standardizing the results of prothrombin time tests, no matter the testing method. So your doctor can understand results in the same way even when they come from different labs and different test methods. Using the INR system, treatment with blood-thinning medicine (anticoagulant therapy) will be the same. In some labs, only the INR is reported and the PT is not reported.Blood clotting factors are needed for blood to clot (coagulation). Prothrombin, or factor II, is one of the clotting factors made by the liver. Vitamin K is needed to make prothrombin and other clotting factors. Prothrombin time is an important test because it checks to see if five different blood clotting factors (factors I, II, V, VII, and X) are present.

• The prothrombin time is made longer by:
• 1. Blood-thinning medicine, such as heparin. [Another test, the activated partial thromboplastin time (APTT) test, is a better test to find out if the right dose of heparin is being used.]
• 2. Low levels of blood clotting factors.
• 3. A change in the activity of any of the clotting factors.
• 4. The absence of any of the clotting factors.
• 5. Other substances, called inhibitors, that affect the clotting factors.
• 6. An increase in the use of the clotting factors.
• NOTE: An abnormal prothrombin time is often caused by liver disease or injury or by treatment with blood thinners.

Anticoagulant, antithrombotic

Low-molecular-weight heparin (LMWH)

Binds to antithrombin III inactivting factors Xa/IIa, thereby resulting in a higher ratio of anti-factor Xa to IIa

Prevention of deep vein thrombosis (DVT), [inpatient or outpatient], PE (pulmonary embolism), [inpatient] in hip and knee replacement, abdominal surgery at risk for thrombosis; unstable angina/non-Q-wave MI

• Hypersensitivity to this product, benzyl alcohol, heparin, pork*; active major bleeding, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpur, heparin-induced thrombocytopenia
• * indicates an unusual finding

• Pregnancy (B)
• Breastfeeding
• Children
• Geriatric patients 
• Low weight men (<57 kg), women (<45 kg)
• Severe renal/hepatic disease
• Blood dyscrasias
• Severe hypertension
• Subacute bacterial endocarditis
• Acute nephritis
• Recent burn
• Spinal surgery
• Indwelling catheters
• BLACK BOX WARNING: Lumbar puncture, epidural anesthesia, and spinal anesthesia

• Only after screening patient for bleeding disorders (PT)
• Do no mix with other products or inf fluids
• **ONLY this product when ordered; not interchangeable wth heparin or other LMWHs
• At same time each day to maintain steady blood levels
• Avoid all IM inj that may cause bleeding
• Prepare in a sterile environment using aseptic technique
• Dilution may be stored for up to 4 wk in glass vial at room temp, up to 2 wk in TB syringes with rubber stoppers at room temp or refrigerated

• "Love Qt Bubbles, but hate to aspirate!"
• SubQ route: DO NOT give IM (begin 1 hour prior to surgery)
• DO NOT aspirate
• Rotate sites
• DO NOT expel the bubble from the syringe before administration
• NOTE: Inject slowly (slow taps) for about 20-30 seconds, wait 10 seconds before pulling out the needle, this will keep the client from getting a bruise

• Common: NONE
• Life threatening: Hemorrhage, hypochromic anemia, thrombocytopenia, and bleeding

• SubQ: 90% absorbed
• Maximum antithrombin activity: 3-5 hour
• Elimination half-life: 4 1/2 hr
• Excreted: In urine

• Blood studies: (Hct/Hgb, CBC, coagulation studies, platelets, occult blood in stools), anti-factor Xa (should be checked 4 hr after inj); thrombocytopenia may occur
• Renal studies: BUN/creatinine baseline and periodically
• Bleeding: Gums, petechiae, ecchymosis, black tarry stools, hematuria - Notify Prescriber
• BLACK BOX WARNING: Neurologic symptoms in patients who have received spinal anesthesia

• Storage at 77 degrees F (25 degrees C)
• Do not freeze

Therapeutic response: Prevention of DVT

• To use soft-bristle toothbrush: To avoid bleeding gums
• To use electric razor: To avoid bleeding from nicks/cuts
• To report any signs of bleeding: gums, under skin, urine, and stools
• To avoid OTC products containing aspirin (anticoagulant) unless approved by prescriber

• Protamine SO₄ 1% sol
• Dose should equal dose of enoxaparin

Anticoagulant

Coumarin derivative

Interferes with blood clotting by indirect means; depresses hepatic synthesis of vit K-dependent coagulation factors (II, VII, IX, X)

Antiphospholipid antibody syndrome, arterial thromboembolism prophylaxis, DVT, MI prophylaxis, after MI, stroke prophylaxis, and thrombosis prophylaxis

Angina and unstable angina

Pregnancy (X), breastfeeding, hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, hepatic disease (severe), malignant hypertension, subacute bacterial endocarditis, acute nephritis, blood dyscrasias, eclampsia, preeclampsia, hemorrhagic tendencies; surgery of CNS, eye; traumatic surgery with large open surface, bleeding tendencies of GI/GU/Respiratory tract, stroke, aneurysms, pericardial effusion, spinal puncture, major regional/lumbar block anesthesia

Geriatric patients, alcoholism, CHF, debilitated patients, trauma, indwelling catheters, severe hypertension, active infections, protein C deficiency, polycythemia vera, vasculitis, severe diabetes, Asian patients (CYP2C9, VKORC1)

• Common: Fever
• Life threatening: NONE

• Common: Diarrhea
• Life threatening: Hepatitis

• Common: NONE
• Life threatening: Hematuria

• Common: NONE
• Life threatening: Hemorrhage, agranulocytosis, leukopenia, and eosinophilia

• Common: Rash
• Life threatening: NONE

• Common: NONE
• Life threatening: Anaphylaxis, exfoliative dermatitis, and purple toe syndrome (blood pools here, can also happen in the fingers)

• Onset: 12-24 hours
• Peak: 1 1/2-4 days
• Duration: 3-5 days
• Effective half-life: 20-60 hours
• Metabolized: In the liver
• Excreted: In the urine, feces (active/inactive metabolites)
• Crosses: placenta
• Bound to plasma proteins: 99% (must have albumin test!)

• 1. Thrombus: Completion of therapy following heparin
• 2. Pulmonary embolism: Completion of therapy following heparin
• 3. Long-term prophylaxis: For thrombus prevention
• 4. Prophylaxis: For atrial fibrillation

• BLACK BOX WARNING:
• Blood studies: (Hct, PT, platelets, occult blood in stools) q3mo
• INR: in hospital daily after 2nd or 3rd dose; when in therapeutic range for 2 consecutive days, monitor 2-3X wk for 1-2 wk then less frequently, depending on stability of INR results
• Outpatient: Moitor every few days until stable dose then periodically thereafter, depending on stability of INR results
• BLACK BOX WARNING: Bleeding gums, petechiae, ecchymosis, black tarry stools, hematuria; fatal hemorrhage can occur
• **Fever, skin rash, and urticaria

Storage in tight container

Therapeutic response: decrease in deep venous thrombosis

• To avoid OTC preparations that may cause serious product interations unless directed by prescriber
• To carry emergency ID identifying product taken
• About the importance of compliance
• To report any signs of bleeding, gums, under skin, urine, stools; to use soft bristle toothbrush to avoid bleeding gums; to use electric razor
• To avoid hazardous activities (football, hockey, skiing), dangerous work
• About the importance of avoiding unusual changes in vitamin intake, diet, or lifestyle
• To inform all health care providers of anticoagulant intake

Administer vitamin K

Treatment and prophylaxis of various bacterial infections

Action taken to prevent disease, by specified means or against a specified disease

• Kills bacteria
• EXAMPLE: like homicidal

Inhibits the growth of susceptible pathogenic bacteria

Determines which antibiotic is effective against a specific organism.

If the antibiotic is working, then such symptoms as fever, melaise, redness, swelling, exudate production, etc. should disappear.

False

False

A one celled organism

Rod shaped

Round shaped

• Penicillins
• Cephalosporins
• Aminoglycosides
• Sulfonamines
• Tetracyclines
• Monobactam
• Erythromycin
• Quinolones

• Penicillins
• Cephalosporins

Bacteriocidal

Cephalosporins

amoxicillin (Rx) Gen-Amoxicillin, Moxatag

cephadroxil (Rx) Keflex

Antiinfective, antiulcer

Aminopenicillin

• Interferes with cell wall replication of susceptible organisms: The cell wall, rendered osmotically unstable, swells and bursts from osmotic pressure
• Bactericidal: Lysis mediated by bacterial cell wall autolysins

• Broad spectrum drug
• Treatment of skin, respiratory, GI, GU infections, otitis media, gonorrhea; for gram-positive cocci (staphylococcus aureaus, Streptococcus pyogenes, Streptococcus . . . ) gram-negative cocci, gram -positive bacilli, gram-negative bacilli . . . etc.

Lyme disease, anthrax treatment and prophylaxis, cervicitis, Chlamydia trachomatis, dental abscess/infection, dyspepsia, gastric ulcer, nongonococcal urethritis (NGU), periodontitis, typhoid fever

Hypersensitivity to penicillins

Pregnancy (B), breastfeeding, neonates, hypersensitivity to cephalosporins, sever renal disease actue lyphocytic leukemia, mononucleosis, phenylketonuria

• PO route 
• Suspension: Shake well before each dose; may be used alone, mixed in drinks; use immediately; discard unused portion after 14 days
• Give: Around the clock
• Caps: May be emptied, mixed with liquids if needed
• Extended Release: Do not crush, chew, or break

• Common: NONE
• Life threatening: Seizures

• Common: Nausea, vomiting, diarrhea
• Life threatening: Pseudomembranous colitis

• Common: NONE
• Life threatening: Bone marrow depression, granulocytopenia, hemolytic anemia

• Common: Urticaria and rash
• Life threatening: NONE

• Common: NONE
• Life threatening: Anaphylaxis, respiratory distress, serum sickness, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis

• Peak: 2 hr
• Duration: 6-8 hr
• Half-life: 1-1 1/3 hr
• Metabolized: In the liver
• Excreted: In the urine
• Crosses: Placenta
• Enters: Breastmilk

• I&O ratio; report hermaturia, oliguria because penicillin in high doses is nephrotoxic (kidneys)
• Hepatic studies: AST, ALT
• Blood studies; WBC, RBC, Hgb, Hct, bleeding time (see HEME side effects)
• Renal studies: Urinalysis, protein, blood, BUN, creatinine (Nephrotoxic)
• C&S before product therapy: Product may be given as soon as the culture is taken
• Pseudomembranous colitis: Bowel pattern before, during treatment; diarrhea, cramping, blood in stools; report to prescriber (see GI side effects)
• Skin eruptions: After administration of penicillin to 1 wk after discontinuing product (stop, assess, and call)
• Respiratory status: Rate, character, wheezing, tightness in chest
• Anaphylaxis: Rash itching, dyspnea, facial/laryngeal edema

• Adequate intake of fluids (2L) during diarrhea episodes
• Scratch test to assess allergy after securing order from prescriber; usually done when penicillin is only product of choice
• Storage in tight container; after reconstituting, oral susp refrigerated for 14 days
• ****MAKE SURE YOU HAVE THESE - IN CASE OF ALLERGIC REACTION: Adrenaline, suction, tracheostomy set, endotracheal intubation equipment on unit

Therapeutic response: absence of infection; prevention of endocarditis (inflammation of heart chambers and/or valves), resolution of ulcer symptoms

• That caps may be opened, contents taken with fluids; that chewable form is available; to take as prescribed, not to double dose
• All aspects of product therapy: to complete entire course of medication to ensure organism death (10-14 days); that culture may be taken after completed course of medication
• To use nonhormonal form of contraception (can render ineffective!)
• To report sore throat, fever, fatigue, diarrhea (superinfection or agranulocytopenia), blood in stool, abdominal pain (pseudomembranous colitis), decreased urinary output.
• That product must be taken in equal intervals around the clock to maintain blood levels; to take without regard to food
• ****To wear or carry emergency ID if allergic to penicillins

• Withdraw product
• Maintain airway
• Administer EPINEPHrine
• Aminophylline
• O₂
• IV Corticosteroids

Antiinfective

Cephalosporin (1st generation)

Inhibits bacterial cell wall synthesis; renders cell wall osmotically unstable, leads to cell death; lysis mediated by cell wall autolytic enzymes

Gram-negative bacilli: Escherichia coli, Proteus mirabilis, Klebsiella (UTI only); gram-positive organisms: Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus; upper, lower respiratory tract, urinary tract, skin infections; otitis media, tonsillitis; UTIs

Hypersensitivity to cephalosporins, infants < 1 mo

Pregnancy (B), breastfeeding, hypersensitivity to penicillins, renal disease

• For 10-14 days to ensure organism death, prevent superinfection
• With food if needed for GI symptoms
• Shake suspension, refrigerate, discard after 2 wk
• After C&S completed

• Common: NONE
• Life threatening: Seizures

• Common: Diarrhea, anorexia
• Life threatening: Pseudomembranous colitis

• Common: NONE
• Life threatening: Nephrotoxicity and renal failure

• Common: NONE
• Life threatening: Leukopenia, thrombocytopenia, agranulocytosis, neutropenia, lymphocytosis, eosinophilia, pancytopenia, hemolytic anemia

• Common: NONE
• Life threatening: Anaphylaxis, serum sickness, Stevens-Johnson syndrome

Blood issues!!

• Peak: 1 - 1 1/2 hr
• Duration: 12-24 hr
• Half-life: 1-2 hr
• 20%: Bound by plasma proteins
• Crosses: Placenta
• Excreted: In breastmilk

Increase: prothrombin time - anticoagulants; use cautiously

• Sensitivity to penicillin and other cephalosporins
• Nephrotoxicity: Increased BUN, creatinine
• Urine output: If decreasing, notify prescriber
• I&O daily
• Blood studies: AST, ALT, CBC, Hct, bilirubin, LDH, alk phos, Coombs' test monthly if patient is on long-term therapy
• Electrolytes: K, Na, Cl monthly if patient is on long-term therapy
• Pseudomembranous colitis: bowel pattern daily; if severe diarrhea occurs, product should be discontinued
• Anaphylaxis: rash, urticaria, pruritus, chills, fever, joint pain; angioedema; may occur a few days after therapy begins; discontinue product, notify prescriber immediately, keep emergency equipment nearby
• Bleeding: ecchymosis, bleeding gums, hematuria, stool guaiac daily
• OVERGROWTH OF INFECTION: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum

Therapeutic response: decreased symptoms of infection, negative C&S

• To use yogurt or buttermilk to maintain intestinal flora, decrease diarrhea
• To take all medication prescribed for length of time ordered
• To report sore throat, bruising, bleeding, joint pain (may indicate BLOOD  DYSCRASIAS [rare]); diarrhea with mucus, blood (may indicate PSEUDOMEMBRANOUS COLITIS)

• EPINEPHrine
• Antihistamines
• Resuscitate if needed

• Bacteriostatic (may be bactericidal)
• Broad spectrum
• Used for client's who are sensitive to penicillin

Antiinfective

macrolide (azalide)

Binds to 50S ribosomal subunits of susceptible bacteria and supresses protein synthesis; much greater spectrum of activity than erythromycin; more effective against gram-negative organisms

Mild to moderate infections of the upper respiratory tract, lower respiratory tract; uncomplicated skin and skin structure infections caused by Moraxella catarrbalis, Streptococcus pneumoniae, Streptococcus pyogenes . . .

Hypersensitivity to azithromycin, erythromycin, and any macrolide

Pregnancy (B), breastfeeding; geriatric patients; renal/hepatic/cardiac disease; <6 mo for otitis media; <2 yr for pharyngitis, tonsillitis

• Common: Nausea, vomitting, diarrhea
• Life threatening: Hepatotoxicity, CHOLESTATIC JAUNDICE, pseudomembranious colitis

• Common: NONE
• Life threatening: ANGIOEDEMA (hives under the skin [dermis]), Stevens-Johnson syndrome, toxic epidermal necrolysis

• PO
• Peak: 2-4 hr
• Duration: 24 hr
• IV
• Peak: End of inf
• Duration: 24 hr
• Half-life: 11-57 hr
• Excreted: In bile, feces, urine, primarily as unchanged product
• NOTE: May be inhibitor of P-glycoprotein

• Increase: Toxicity - ergotamine
• INCREASE: Dysrhythmias - pimozide: fatal reaction

• I&O ratio; report hematuria, oliguria with renal disease
• Hepatic studies: AST, ALT, CBC with differential
• Renal studies: urinalysis, protein blood
• C&S before product therapy; product may be taken as son as culture is taken; C&S may be repeated after treatment
• SERIOUS SKIN REACTIONS: Stevens-Johnson syndrome, toxic epidermal necrolysis, ANGIOEDEMA; discontinue if rash develops, treat symptomatically
• SUPERINFECTION: sore throat, mouth, tongue; fever, fatigue, diarrhea, ANOGENITAL PRURITUS (itching at the anus and genetils)
• PSEUDOMEMBRANOUS COLITIS: diarrhea, abdominal pain, fever, fatigue, anorexia; obtain CBC, serum albumin
• Bowel pattern before during treatment
• Respiratory status: rate, character; wheezing, tightness in chest: discontinue product

Storage at room temperature

Therapeutic response: C&S negative for infection; decreased signs of infection

• To report sore throat, fever, fatigue, severe diarrhea, anal/genital itching 9may indicate superinfection)
• Not to take aluminum-magnesium-containing antacids simultaneously with this product (PO)
• To notify nurse of diarrhea, dark urine, pale stools; yellow discororation of eyes, skin; severe abdominal pain (LIVER FAILURE - JAUNDICE)
• To complete dosage regimen

Antiinfective - broad spectrum

Fluoroquinolone

Interferes with conversion of intermediate DNA fragments into high-molecular-weight DNA in bacteria; DNA gyrase inhibitor

Infection caused by susceptible Escherichia coli, Enterobacter cloacae, Proteus mirabilis . . . .

Hypersensitivity to quinolones

• Pregnancy (C), breastfeeding, children, geriatric patients, renal disease, epilepsy, QT prolongation, HYPOKALEMIA
• BLACK BOX WARNING: Tendon pain/rupture, TENDINITIS

Do not use theophylline with this product, will cause toxicity.

• Common: Headache, restlessness
• Life threatening: Seizures

• Common: nausea, diarrhea
• Life threatening: Pseudomembranous colitis

• Common: NONE
• Life threatening: BONE MARROW DEPRESSION

• Common: Rash
• Life threatening: Toxic epidermal necrolysis

• Common: NONE
• Life threatening: Anaphylaxis, Stevens-Johnson syndrome

• Common: NONE
• Life threatening: TENDON RUPTURE

• Peak: 1 hr
• Half-life: 3-4 hr
• Excreted: In urine as active product
• Metabolites: 35-40%
• Protein binding: 20-40%

• Infection: WBC, temperature before treatment, periodically
• CNS symptoms: headache, dizziness, fatigue, insomnia, depression
• Renal, hepatic studies: BUN, creatinine, AST, ALT
• I&O ratio: urine pH < 5.5 is ideal
• ANAPHYLAXIS: Fever, flushing, rash, urticaria, pruritus, dyspnea (Must take a temperature first!)
• NOTE: For tendon pain, especially in children

Limited intake of alkaline foods, products: milk, dairy products, alkaline antacids, sodium bicarbonate; caffeine intake if excessive cardiac or CNS stimulation

Therapeutic response: decreased pain, frequency, urgency, C&S; absence of infection

• Not to take any products tht contain magnesium, calcium (such as antacids), iron, aluminum with this product or within 2 hr of product
• To report tendon pain, chest pain, palpitations
• To ambulate, perform activities with assistance if dizziness occurs
• To complete full course of product therapy; not to double or miss doses
• To contact prescriber if adverse reaction occurs, if inflammation or pain in tendon occurs
• TO FREQUENTLY RINSE MOUTH; USE SUGARLESS CANDY, GUM FOR DRY MOUTH
• NOTE: To contact prescriber if taking theophylline (used to prevent and treat wheezing, shortness of breath, and difficulty breathing caused by asthma, chronic bronchitis, emphysema, and other lung diseases. It relaxes and opens air passages in the lungs, making it easier to breathe.)

• Antiinfective
• BIG GUNS!!!

Aminoglycoside

Interferes with protein synthesis in bacterial cell by binding to ribosomal subunit, thus causing misreading of genetic code; inaccurate peptide sequence forms in protein chain, thereby causing bacterial death

Sever systemic infections of CNS, respiratory, GI, urinary tract, bone, skin, soft tissues caused by susceptible strains of Pseudomonas aeruginosa, Proteus, Klebsiella, Serratia, Escherichia coli, Enterobacter, Citrobacter, Staphylococcus, Shigella, Salmonella, Acinetobacer, Bacillus anthracis, acute PID

• Hypersensitivity to this product, other aminoglycosides; fungal/viral/mycobacterial infection
• BLACK BOX WARNING: Pregnancy (D), severe renal disease

• Breastfeeding, neonates, geriatric patients
• BLACK BOX WARNING: Mild renal disease, hearing deficits, myasthenia gravis, Parkinson's disease, infant botulism

• Common: NONE
• Life threatening: Seizures, neurotoxicity

• Common: DEAFNESS
• Life threatening: OTOTOXICITY

• Common: Nausea, vomitting, anorexia
• Life threatening: Hepatic necrosis

• Common: NONE
• Life threatening: Oliguria, hematuria, renal damage, azotemia (excessive amounts of toxic wastes not filtered), renal failure, nephrotoxicity

• Common: NONE
• Life threatening: Agranulocytosis, thrombocytopenia, leukopenia

• Common: Rash
• Life threatening: NONE

• Metabolized: No
• Excreted: Unchanged in urine
• Crosses: Placental barrier
• IM
• Onset: Rapid
• Peak: 1-2 hr
• IV
• Onset: Immediate
• Peak: 1-2 hr
• Infants: 6-7 hr
• Duration: 6-8 hr

• BLACK BOX WARNING: 
• NEUROMUSCULAR DISEASE (MYASTHENIA GRAVIS, PARKINSON'S DISEASE, INFANT BOTULISM): Paresthesias, tetany, positive Chvosteks's/Trousseau's signs (HYPOcalciumia), confusion (adults), tetany, muscle weakness (infants); correct electrolyte imbalance
• Weight before treatment; calculation of dosage is usually based on ideal body weight but may be calculated on actual body weight
• BLACK BOX WARNING: 
• RENAL DISEASE: I&O ratio, urinalysis daily for proteinuria, cells, casts; report sudden change in urine output; urine pH if product is used for UTI; urine should be kept alkaline; urine for CCr testing, BUN, serum cratinine; lower dosage should be given with renal impairment (CCr <80 ml/min); toxicity is increased in patients with decreased renal function of high doses are given
• VS during inf; watch for hypotension, change in pulse
• IV site for thrombophlebitis, including pain, redness, swelling q30min, change site if needed, discontinue, apply warm compresses to site
• SERUM PEAK DRAWN AT 30-60 MIN AFTER IV INF OR 60 MIN AFTER IM INJECTION AND TROUGH LEVEL DRAWN JUST BEFORE NEXT DOSE: Blood level should be 2-4 times bacteriostatic level; peak (5-10 mcg/ml), trough (0.5-2 mcg/ml), depending on type of infection
• BLACK BOX WARNING:
• HEARING DEFICITS: Eighth cranial nerve dysfunction by audiometric testing; also ringing, roaring in ears, vertigo; assess hearing before, during, after treatment
• Dehydration: high specific gravity, decrease in skin turgor, dry mucous membranes, dark urine
• OVERGROWTH OF INFECTION: fever, malaise, redness, pain, swelling, perineal itching, diarrhea, stomatitis, change in cough or sputum
• C&S before starting treatment to identify infecting organism
• VESTIBULAR DYSFUNCTION: nausea, vomiting, dizziness, headache; product should be discontinued if severe
• Inj sites for redness, swelling, abscesses; use warm compresses at site

• Adequate fluids of 2-3 L/day unless contraindicated to prevent irritation of tubules
• Supervised ambulation, other safety measures with vestibular dysfunction

Therapeutic response: absence of fever, draining wounds, negative C&S after treatment

• To report headache, dizziness, symptoms of overgrowth of infection, renal impairment
• To report loss of hearing: ringing, roaring in the ears, feeling of fullness in the head

• 1. Assess for s/s infection prior to and throughout therapy
•  2. Advise patient to notify healthcare preofessional if symptoms donot improve or if they worsen
•  3. Obtain C&S prior to initiating therapy - first dose may be given prior to receiving results
•  4. Handle/store/administer drug, per manufacturer guidelines
•  5. Monitor lab values, as indicated
•  6. Most antibiotics should be administered around the clock to maintain herapeutic serum levels
•  7. Stress importance of completing full course of therapy

• Determine previous hypersensitivities
• Be aware of cross-sensitivities (ex, penicillins & cephalosporins)
• Advise pt to report signs of superinfection, allergy, serious side effects
• Prophylactic yogurt, acidophilus
• Mouth care/ice chips if stomatitis occurs
• maintain adequate hydration
• Compresses/gentle massage to painful injections sites