Generic Name: Cefuroxime Axetil Cefuroxime Sodium Brand Name: Cefuroxime Axetil (Ceftin [P.O.

]) Cefuroxime Sodium (Zinacef [Parenteral]) Available Forms: Cefuroxime Axetil Suspension: 125 mg / 5 ml, 250 mg / 5 ml Tablets: 125 mg, 250 mg, 500 mg Cefuroxime Sodium Infusion: 750 mg, 1.5 g premixed, frozen solution Injection: 750 mg, 1.5 g Indications: * Pharyngitis, tonsillitis, infections of the urinary and lower respiratory tracts, and skin and skin-structure infections caused by Streptococcus pneumoniae and S. pyogenes, Haemophillus influenzae, Staphylococcus aureus, Escherichia coli, Moraxella catarrhalis (including beta-lactamase-producing strains), Neisseria gonorrheae, and Klebsiella and Enterobacter species. * Serious lower respiratory tract infections, UTIs, skin and skin-structure infections, bone and joint infections, septicemia, meningitis, and gonorrhea * Uncomplicated UTIs * Otitis Media * Pharyngitis and Tonsillitis * Perioperative Prevention * Early Lyme Disease (erythema migrans) caused by Borrelia burgdorferi * Secondary bacterial infection of acute bronchitis * Uncomplicated gonorrhea * Acute bacterial maxillary sinusitis caused by Streptococcus pneumoniae or Haemophilus influenza (only strains that dont produce beta-lactamase) Mechanism of Action: Second-generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal. Adverse Reactions: CV: phlebitis, thrombophlebitis GI: pseudomembranous colitis, nausea, anorexia, vomiting, diarrhea Hematologic: transient neutropenia, eosinophilia, hemolytic anemia, thrombocytopenia Skin: maculopapular and erythematous rashes, urticaria, pain, induration, sterile abscesses, temperature elevation, tissue sloughing at intramuscular injection site Other: hypersensitivity reactions, serum sickness, anaphylaxis. Effects on Lab Test Results: * May increase ALT, AST, alkaline phosphatase, bilirubin, and LDH levels. May decrease hemoglobin and hematocrit level. * May increase PT and INR and eosinophil count. May decrease neutrophil and platelet counts. * May falsely increase serum or urine creatinine level in tests using Jaffe reaction. May cause false-positive results of Coombs test and urine glucose tests using cupric sulfate (Benedicts reagent or Clinitest). Contraindications and Cautions: * Contraindicated in patients hypersensitive to drug. * Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other beta-lactam antibiotics. * Use with caution in breast-feeding women and in patients with history of colitis or renal sufficiency. Responsibilities: * Before administering, make sure patient is not allergic to penicillins or cephalosporins. * Absorption of cefuroxime axetil is enhanced by food. * Cefuroxime axetil tablets may be crushed if swallowing is a difficulty. Cefuroxime axetil tablets may be

dissolved in small amounts of apple, orange or grape juice, even chocolate milk. However, drugs bitter taste is difficult to mask even with food. * High-fat meals increased drug bioavailability. * ALERT! Cefuroxime axetil film-coated tablet and oral suspension are not bioequivalent. * If large doses are given, therapy is prolonged, or patient is at high risk, monitor patient for signs and symptoms of superinfection. * Unlike other second generation cephalosporins, cefuroxime can cross the blood-brain-barrier. * ALERT! Do not confuse with other cephalosporins that sound alike. * Take medication as prescribed, even after feeling better. * Take oral form with food. * If suspension is being used, shake the container well before measuring dose. * Notify prescriber about rashes or superinfections. * Notify prescriber about loose stools or diarrhea

Generic Name: Acetylcysteine Brand Name: Fluimucil Classification: Mucolitic Mode of Action: Splits links in mucous proteins contained in respiratory mucous secretion decreasing viscosity of mucous. Indication: acute and chronic respiratory tract affections with abundant mucus Contraindication: Hypersensitivity to acetylcystein; patients at risk of gastric hemorrhage Side Effect: Headache, Dizziness, drowsiness, fever, chills, constipation, anorexia Adverse Effect: Uticaria, bronchospasm, nausea, vomiting Drug Interaction: Drug: Do not mix with antibiotics: tetracycline, chloretetracycline, oxytetracycline, erythromycin, lactocionate, amphotericin B, sodium ampicillin Food: Do not use with iron, copper Nursing Responsibilities Monitor for signs and symptoms of aspiration of excess secretions, and for bronchospasm Report difficulty with clearing the airway or any other respiratory distress Monitor for improvement in dyspnea and sputum clearance Monitor for adverse effects Monitor for S/s of hypersensitivity Monitor effectiveness of therapy Assess cough: type, frequency, character including sputum Monitor vital signs, cardiac status Assess for rate, rhythm of respirations, including dyspnea: sputum

Zinc Sulfate
Written by admin Drug study Feb 20, 2011 Generic Name: Zinc Sulfate Brand Names: Eye-SedVerazinc, Zinc 15, Zinc-220, Zinca-Pak Classification: Vitamins and Minerals Suggested Dose:
y y y y

Solution

0.25%,

Orazinc

Adults: 2.5 to 4 mg IV daily. Add 2 mg daily for acute catabolic states Stable adults with fluid loss from the small bowel: Give an additional 12.2 mg zinc per liter of TPN solution, or an additional 17.1 mg per kg of stool or ileostomy output. Full-term infants and children younger than age 5: 100mcg/kg IV daily Premature infants weighing up to 3 kg (3.3 to 7 lb): 300mcg/kg IV daily

Mode of Action:
y

Participate in synthesis and stabilization of proteins and nucleic acids in transport systems.

subcellular and membrane

Indication:
y y y

To prevent individual trace element deficiencies in patients receiving long term total parenteral nutrition (TPN) Acts as integral part of several enzymes important to protein and carbohydrate metabolism, wound healing, maintenance of normal growth and skin hydration, and senses of taste and smell. Ophthalmic solution used as mild astringent for relief of eye irritation.

Contraindication:
y y

hypersensitive to iodine Use cautiously: Lactating and Pregnant Women

Side Effects:
y

Nausea, stomach upset, heartburn may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Tell your doctor immediately if any of these unlikely but serious side effects occur: fever, chills, sore throat, sores in mouth, unusual tiredness, weakness

Adverse Effects: none reported Drug Interactions: Drug-Drug The following drugs can interact with or be made less effective by zinc sulfate.
y y y y y

a blood thinner such as warfarin (Coumadin); methyltestosterone (Android, Methitest, Oreton); penicillamine (Cuprimine, Depen); risedronate (Actonel); a tetracycline antibiotic such as demeclocycline (Declomycin), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap); or

an antibiotic such as ciprofloxacin (Cipro), ofloxacin (Floxin), norfloxacin (Noroxin), levofloxacin (Levaquin), lomefloxacin (Maxaquin), and others.

Drug-Food
y

Avoid taking this medication with foods that are high in calcium or phosphorus, which can make it harder for your body to absorb zinc sulfate. Foods high in calcium or phosphorus include milk, cheese, yogurt, ice cream, dried beans or peas, lentils, nuts, peanut butter, beer, cola soft drinks, and hot cocoa.

Nursing Responsibilities: 1. Check levels of trace elements in patients who have received TPN for 2 months or longer. Give supplement, if ordered. Report low levels of thee elements. 2. Normal level is 88 to 112 mcg/dl zinc. 3. Solutions of trace elements are compounded by pharmacist for addition to TPN solutions according to various formulas. 4. Explain need for zinc administration to patient and family. 5. Tell patient to report signs of hypersensitivity promptly. 6. Inform patient and family that trace elements are normally received from dietary intake that, when patient begins eating well, supplements wont be needed

GENERIC NAME: Ranitidine Hydrochloride BRAND NAME: Zantac CLASSIFICATION: Anti-ulcer drug, H2 receptor antagonist SUGGESTED DOSE: Active duodenal and gastric ulcer: * Adults: 150mg P.O, b.i.d or 300 mg daily at bedtime; Or, 50 mg I.V. or I.M. every 6 to 8 hours. Maximum daily I.V. dose, 400mg; or, 150 mg by continuous infusion at 6.25 mg/hour over 24 hours. * Children ages 1 month to 16 years: For duodenal and gastric ulcers only, 2 to 4 mg/kg P.O. b.i.d., up to 300mg/day Maintenance therapy for duodenal or gastric ulcer * Adults: 150 mg P.O at bedtime * Children ages 1 month to 16 years: 2 to 4 mg/kg P.O daily, up to 150 mg daily Pathologic hypersecretory conditions, such as Zollinger-Ellison syndrome (ZES) * Adults: 150 mg P.O. b.i.d.; doses up to 6 g or more frequent intervals may be needed in patients with severe disease; Or, infuse continuously at 1 mg/kg/hour. After 4 hours, if patient remains symptomatic or gastric acid output is greater than 10mEq/hour, increase dose in increments of 0.5 mg/kg/hour and recheck gastric acid output. Doses up tot 2.5 mg/kg/hour and infusion rates up to 220 mg/hour have been used Gastroesophageal reflux disease * Adults: 150 mg P.O. b.i.d * Children ages 1 month to 16 years: 5 to 10 mg/kg P.O. daily given as two divided doses.

Erosive esophagitis * Adults: 150 mg P.O. q.i.d. Maintenance dosage is 150 mg P.O. b.i.d. * Children ages 1 month to 16 years: 5 to 10 mg/kg P.O. daily given as two divided doses. Heartburn * Adults and children ages 12 and older: 75 mg of Zantac 75 P.O as symptoms occur, up to 150 mg daily, not exceed 2 weeks of continuous treatment. * Adjust-a-dose: For patients with creatinine clearance below 50 ml/minute, 150mg P.O. q 24 hours or 50 mg I.V. q 18 to 24 hours. MODE OF ACTION: Competitively inhibits gastric acid secretion by blocking the effect of histamine on histamine H2 receptors. Both daytime and nocturnal basal gastric acid secretion, as well as food- and pentagastrin-stimulated gastric acid are inhibited. Weak inhibitor of cytochrome P-450 (drug-metabolizing enzymes); thus, drug interactions involving inhibition of hepatic metabolism are not expected to occur. INDICATION: - Short-term (4-8 weeks) and maintenance of duodenal ulcer - Pathologic hypersecretory conditions such as Zollinger-Ellison syndrome and systemic mastocytosis. - Short-term treatment of active, benign gastric ulcers and maintenance treatment after healing the acute ulcer - Treatment of GERD - Treatment of endoscopically diagnosed erosive esophagitis and maintenance of healing of erosive esophagitis. - IV in some hospitalized clients with pathological hypersecretory conditions or intractable duodenal ulcers, or as an alternative to PO doses for short-term use in those who are unable to take PO medication CONTRAINDICATION: - Contraindicated in patients hypersensitive to drug and those with acute porphyria - Cirrhosis of the liver, impaired renal or hepatic function. PRECAUTION: - Use with caution during lactation, in the elderly, and in clients with decreased hepatic or renal function. DRUG INTERACTIONS: Antacids: may decrease ranitidine absorption Cyanocobalamin: decrease Cyanocobalamin absorption relatedto increase gastric PH Diazepam: decrease diazepam effects related to decrease GI tract absorption. Glipizide: increase Glipizide effect Procainamide: decrease procainamide excretion leads to possible increase effect Smoking: decrease rate of ulcer healing

Theophylline: possible increase theophylline pharmacologic and toxicologic effects Warfarin: may increase warfarin hypoprothrombinemic effects SIDE EFFECTS: GI: Constipation, N&V, diarrhea, abdominal pain, pancreatitis (rare) CNS: Headache, dizzinessk, malaise, insomnia, vertigo, confusion, anxiety, agitation, depression, fatigue, somnolence, hallucinations. CV: Bradycardia or tachycardia, premature ventricular beats following rapid IV use (especially in clients predisposed to cardiac rhythm disturbances), vasculitis. Hematologic: Thrombocytopenia, ganulocytopenia, leucopenia, pancytoenia (sometimes marrow hypoplasia) Hepatic: Hepatotoxicity, jaundice, hepatitis, increase in ALT Dermatologic: Erythema multiforme, rash, alopecia Allergic: angioneurotic edema (rare), rashes, fever, eosinophili Miscellaneous: Arthralgia, gynecomastia, impotence, loss of libido, blurred vision, pain at injection site, local burning or itching following IV use. ADVERSE EFFECTS: CV: cardiac arrest Hematologic: agranulocytosis, autoimmune hemolytic or aplastic anemia Allergic: Bronchospasm, anaphylaxis NURSING RESPONSIBILITIES: 1. Assess patient for abdominal pain. Note presence of blood in emesis, stool or gastric aspirate. 2. Visually inspect parenteral drug product for particulate matter and discoloration before administration. 3. Determine if the patient is pregnant or lactating. 4. Skin tests using allergens may elicit false negative results; stop drug 24-72 hours prior to testing. 5. Monitor renal and hepatic function. 6. Instruct patient to take as directed with or immediately following meals. Wait 1 hour before taking an antacid. 7. Instruct patient not to drive or operate machinery until drug effects are realized; dizziness or drowsiness may occur. 8. Encourage patient to avoid, alcohol, aspirin-containing products, and beverages that contain caffeine (tea, cola, coffee); these increase stomach acid. 9. Urge patient to avoid cigarette smoking because this may increase gastric acid secretion and worsen disease; it interferes with healing and drugs effectiveness. 10. Advise patient to report any evidence of yellow discoloration of skin or eyes, or diarrhea. 11. Report as scheduled to determine extent of healing and expected length of therapy.

Generic name: Metoclopramide HCL Brand Name: Apo-Metoclop, Clopra, Reglan Classification: Antiemetic drug Suggested Dose: Adults 1-20 mg/kg IV 30 minutes before chemotherapy; repeat q 2 hours for two doses, then q 3 hours for three doses. 10 to 20 mg IM near end of surgical procedure; repeat q4 to 6 hours, prn. . 5 to 10 mg PO or 5-20 mg IV or IM tid. Indication: To prevent or reduce postoperative nausea and vomiting from emetogenic cancer chemotherapy, postoperative nausea and vomiting, and emesis during pregnancy. Contraindication: contraindicated with hypersensitivity to the drug and in those pheochromocytoma and seizure disorders. Action: stimulates motility of upper GI tract, increases lower esophageal sphincter tone, and block dopamine receptor at the chemoreceptor trigger zone Drug interaction: Anticholinergics and opoiod analgesics: may antagonize GI motility effects of metopclopramide. Use together cautiously CNS depressants: may cause addictive effect. Avoid using together. Levodopa: levodopa and metoclopromide have opposite effects on dopamine receptor. Avoid using together MAO inhibitors: may increase release of catecholamines in patiet with hypertension. Phenothiazines: may increase risk of extrapyramidal effects. Monitor patient closely. Adverse reaction: CNS: restlessness, anxiety, drowsiness, fatigue, lassitude, fever, depression, akathisia, insomnia, confusion, suicide ideation, seizures, neuroleptic malignant syndrome, hallucinations, headache, dizziness, extrapyramidal effect. CV: transient hypertension, hypotension, supraventricular tachycardia, bradycardia, GI: constipation, dry mouth, nausea Nursing Responsibilities: 1. 2. 3. 4. 5. 6. Monitor bowel sounds Monitor VS prior to drug administration. Tell the patient to avoid driving activities and heavy lifting. Tell the patient to avoid activities that requires alertness for 2 hrs after doses. Urge patient to report persistent or serious adverse reaction promptly. Advise patient not to drink alcohol during therapy.

ampicillin (am pi sill in) ampicillin sodium Oral: Ampicin (CAN), Apo-Ampi (CAN), Novo-Ampicillin (CAN), Nu-Ampi (CAN), Penbritin (CAN), Principen Pregnancy Category B Drug classes
y y

Antibiotic Penicillin

Therapeutic actions
y

Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall, causing cell death.

Indications
y

y y

Treatment of infections caused by susceptible strains of Shigella, Salmonella, Escherichia coli, Haemophilus influenzae, Proteus mirabilis, Neisseria gonorrhoeae, enterococci, gram-positive organisms (penicillin Gsensitive staphylococci, streptococci, pneumococci) Meningitis caused by Neisseria meningitidis Unlabeled use: Prophylaxis in cesarean section in certain high-risk patients

Dosage & route

y

Maximum recommended dosage, 814 g/day (reserve 14 g for serious infections, such as meningitis, septicemia); may be given IV, IM, or PO. Use parenteral routes for severe infections; switch to oral route as soon as possible.

ADULTS
y

y y y

Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 2 g ampicillin IM or IV with gentamicin 1.5 mg/kg IM or IV within 30 minutes of starting procedure. Six hours later, give 1 g ampicillin IM or IV or 1 g amoxicillin PO. Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 2 g ampicillin IM or IV within 30 minutes of procedure. STDs in pregnant women and patients allergic to tetracycline: 3.5 g ampicillin PO with 1 g probenecid. Prophylaxis in cesarean section: Single IV or IM dose of 25100 mg/kg immediately after cord is clamped.

ADULTS AND PEDIATRIC PATIENTS

y

Respiratory and soft-tissue infections:

> 40 kg: 250500 mg IV or IM q 6 hr. < 40 kg: 2550 mg/kg/day IM or IV in equally divided doses at 68 hr intervals. > 20 kg: 250 mg PO q 6 hr. < 20 kg: 50 mg/kg/day PO in equally divided doses q 68 hr.
y

GI and GU infections, including women with N. gonorrhoeae:

> 40 kg: 500 mg IM or IV q 6 hr. < 40 kg: 50100 mg/kg/day IM or IV in equally divided doses q 68 hr. > 20 kg: 500 mg PO q 6 hr. < 20 kg: 100 mg/kg/day PO in equally divided doses q 68 hr.

y y y

Gonococcal infections: 500 mg q 6 hr for penicillin-sensitive organism or for patients > 45 kg, single dose of 3.5 g PO with 1 g probenecid. Bacterial meningitis: 150200 mg/kg/day by continuous IV drip and then IM injections in equally divided doses q 34 hr. Septicemia: 150200 mg/kg/day IV for at least 3 days, then IM q 34 hr.

PEDIATRIC PATIENTS
y

Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 50 mg/kg ampicillin IM or IV with 1.5 mg/kg gentamicin IM or IV within 30 minutes of procedure. Six hours later give 25 mg/kg ampicillin IM or IV or 25 mg/kg amoxicillin PO. Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 50 mg/kg ampicillin IM or IV within 30 minutes of procedure.

Adverse effects
y y y

y y y y y

CNS: Lethargy, hallucinations, seizures CV: CHF GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black hairy tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis GU: Nephritis Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time Hypersensitivity: Rash, fever, wheezing, anaphylaxis Local: Pain, phlebitis, thrombosis at injection site (parenteral) Other: Superinfectionsoral and rectal moniliasis, vaginitis

Contraindications and cautions

y y

Contraindicated with allergies to penicillins, cephalosporins, or other allergens. Use cautiously with renal disorders.

Nursing considerations Assessment

y y

History: Allergies to penicillins, cephalosporins, or other allergens; renal disorders; lactation Physical: Culture infected area; skin color, lesion; R, adventitious sounds; bowel sounds; CBC, LFTs, renal function tests, serum electrolytes, Hct, urinalysis

Interventions
y y y y

Culture infected area before treatment; reculture area if response is not as expected. Check IV site carefully for signs of thrombosis or drug reaction. Do not give IM injections in the same site; atrophy can occur. Monitor injection sites. Administer oral drug on an empty stomach, 1 hr before or 2 hr after meals with a full glass of water; do not give with fruit juice or soft drinks.

Teaching points
y y y y y y

Take this drug around-the-clock. Take the full course of therapy; do not stop taking the drug if you feel better. Take the oral drug on an empty stomach, 1 hour before or 2 hours after meals; do not take with fruit juice or soft drinks; the oral solution is stable for 7 days at room temperature or 14 days refrigerated. This antibiotic is specific to your problem and should not be used to self-treat other infections. You may experience these side effects: Nausea, vomiting, GI upset (eat frequent small meals), diarrhea. Report pain or discomfort at sites, unusual bleeding or bruising, mouth sores, rash, hives, fever, itching, severe diarrhea, difficulty breathing.