Drug Study Classification Brand Name/Generic Name Mechanism of Action GENERIC NAME Clindamycin Brand Names Anerocin, Clindal,

Dalacin, Dalacin C, Inprosyn-HP, Klindex, and Zindal Dose/Frequency/Route Indications Contraindications Dose/Frequency/Route 300 mg 1 amp TID 300 mg/cap 1 cap every 8 hours for 7 days Side Effects Contraindications Abdominal pain Nausea and Vomiting Diarrhea Vaginitis and itching Dry scaly skin Phlebitis, thrombophlebitis with IV administration Pain, induration, at the IM injection site Allergic reaction, urticaria, pruritus Headache and dizziness Contact dermatitis Hypersensitivity reaction Nursing Interventions
Store capsules at room temperature After reconstitution, oral solution is stable for 2 weeks at room temperature. Do not refrigerate oral solution to avoid thickening. Give with 8 oz water. Question patient for history of allergies, particularly to clindamycin, lincomycin, and aspirin. Avoid concurrent use of neuromuscular blocking agents. Monitor bowel activity, stool consistency; report diarrhea promptly due to potential for serious colitis. Assess skin for rash with topical application. Assess for superinfection: severe diaarhea, genital/anal pruritus, increase fever, and change of oral mucosa. Continue therapy for full length of treatment. Doses should be evenly spaced. Oral doses should be taken with 8 oz water. Caution should be used when applying topical clindamycin concurrently with peeling/abrasive acne agents, soaps, alcohol-containing cosmetics to avoid cumulative effect Do not apply topical preparations near eyes, abraded areas. If accidental contact with eyes, rinse with cool tap water. Do not engage in sexual intercourse during treatment.

Indications Treatment of respiratory tract, skin or Classification soft tissue, chronic bone or joint Lincosamide and Antibiotic infections; septicemia; intra-abdominal, female genitourinal infections; bacterial Mechanism of Action vaginosis; endocarditis. Can be used Bacteriostatic. Clindamycin binds to for acne vulgaris. Clindamycin is used bacterial ribosomal receptor sites. for treatment of malaria, otitis media, Topically, it decreases fatty acid Pneumocystis carinii pneumonia, and concentration on skin. It inhibits protein toxoplasmosis. synthesis of bacterial cell wall and prevents outbreak of acne vulgaris. Contraindications -contraindicatedin patientshypersensitive todrug or lincomycin -use cautiously in patients withrenal or hepaticdisease, asthma,history of GIdisease, or significantallergies

Drug Study Classification Brand Name/Generic Name Mechanism of Action GENERIC NAME Mefenamic Acid Brand Names Ponstan, Ponstel Classification Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Mechanism of Action Mefenamic acid inhibits the enzymes cyclooxygenase (COX)-1 and COX-2 and reduces the formation of prostaglandins and leukotrienes. It also acts as an antagonist at prostaglandin receptor sites. It has analgesic and antipyretic properties with minor anti-inflammatory activity. Dose/Frequency/Route Indications Contraindications Dose/Frequency/Route 500 mg 1 cap every 8 hours for pain Indications Pain and inflammation. Contraindications Inflammatory bowel disease; peptic ulcer; neonates; pregnancy (3rd trimester), lactation. Coronary artery bypass graft surgery, severe renal impairment, severe heart failure. Side Effects Adverse Effects Abdominal pain, dyspepsia, constipation, diarrhoea, nausea, GI ulcers; oedema; bronchospasm; headache, drowsiness, insomnia, visual disturbances; CHF, hypertension, tachycardia, syncope; urticaria, rash; thrombocytopenia, aplastic anaemia, agranulocytosis; tinnitus; elevated liver enzymes; abnormal renal function. Potentially Fatal: Autoimmune haemolytic anaemia; convulsions (overdosage). Nursing Interventions Assessment & Drug Effects  Assess patients who develop severe diarrhea and vomiting for dehydration and electrolyte imbalance.  Lab tests: With long-term therapy (not recommended) obtain periodic complete blood counts, Hct and Hgb, and kidney function tests. Patient & Family Education Discontinue drug promptly if diarrhea, dark stools, hematemesis, ecchymoses, epistaxis, or rash occur and do not use again. Contact physician.  Notify physician if persistent GI discomfort, sore throat, fever, or malaise occur.  Do not drive or engage in potentially hazardous activities until response to drug is known. It may cause dizziness and drowsiness.  Monitor blood glucose for loss of glycemic control if diabetic.  Do not breast feed while taking this drug without consulting physician.


Drug Study Classification Brand Name/Generic Name Mechanism of Action GENERIC NAME Ascorbic Acid / Vitamin C Brand Names A-Cee, Ad-C, Alka-C, Cecon, Ceelin, Cenolate, Enervon, and Redoxon Classification Vitamin Mechanism of Action Assists in collagen formation, tissue repair; involved in oxidation reduction reactions, other metabolic reactions. Vitamin C is involved in metabolism; carbohydrate utilization; synthesis of lipids, proteins, carnitine. It also preserves blood vessel integrity. Dose/Frequency/Route Indications Contraindications Dose/Frequency/Route 500 mg 1 cap tab BID Indications Vitamin C is used for prevention and treatment of scurvy, acidification of urine, dietary supplement, prevention of and reduction in the severity of colds. Contraindications Use of sodium ascorbate inpatients on sodiumrestriction; use of calciumascorbate in patientsreceiving digitalis. Safetyduring pregnancy(category C) or lactation isnot established Side Effects Adverse Effects Side Effects Abdominal cramps Nausea Vomiting Diarrhea Increased urination with doses exceeding 1 gram Flushing Headache Dizziness Sleepiness or insomnia Adverse Reactions Urine acidification that may lead to crystalluria Note: Vitamin C increases theabsorption of iron when takenat the same time as iron-richfoods. Nursing Interventions Assessment & Drug Effects Lab tests: Periodic Hct& Hgb, serumelectrolytes. Monitor for S&S of acute hemolyticanemia, sickle cellcrisis. Patient & FamilyEducation Take large doses of vitamin C in dividedamounts because the bodyuses only what is neededat a particular time andexcretes the rest in urine. Megadoses caninterfere withabsorption of vitamin B12

Drug Study Classification Brand Name/Generic Name Mechanism of Action GENERIC NAME
Cefazolin

Dose/Frequency/Route Indications Contraindications Dose/Frequency/Route 1 gm IVTT every 8 hours (-ANST) x 12 doses Indications
Treatment of: Skin & skin structure infections; pneumonia; urinary tract infections; bone & joint infections

Side Effects Adverse Effects CNS: Seizures (high doses) GI: Pseudomembranous colitis, diarrhea, nausea, vomiting, cramps GU: Interstitial nephritis DERM: Rashes, urticaria HEMAT: Blood dyscrasias, hemolytic anemia LOCAL: Pain at IM site, phlebitis at IV site MISC: Allergic reactions including Anaphylaxis and Serum sickness, superinfection

Nursing Interventions
Assess patient for infection (vital signs; appearance of surgical site, urine; WBC) at beginning and during therapy. Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosphorins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before initiating therapy. Observe patient for signs and symptoms of anaphylaxis (rash, pruritis, laryngeal edema, wheezing). Discontinue drug and notify physician or other health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of anaphylactic reaction. Monitor site for thrombophlebitis (pain, redness, swelling). Change sites every 48-72 hr to prevent phlebitis. Instruct patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy. Instruct patient to notify health care professional if fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise not to treat diarrhea without consulting healthcare professional. Assess patient for infection (vital signs; appearance of surgical site, urine; WBC) at beginning and during therapy. Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosphorins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before initiating therapy. Observe patient for signs and symptoms of anaphylaxis (rash, pruritis, laryngeal edema, wheezing). Discontinue drug and notify physician or other health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of anaphylactic reaction. Monitor site for thrombophlebitis (pain, redness, swelling). Change sites every 48-72 hr to prevent phlebitis. Instruct patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy. Instruct patient to notify health care professional if fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise not to treat diarrhea without consulting healthcare professional.

Brand Names
Ancef

Classification Therapeutic: Anti-infectives Pharmacologic: First generation cephalosphorins

Mechanism of Action Bind to bacterial cell wall membrane, causing cell death. Active against many gram-positive cocci including: Streptococcus pneumoniae, Group A beta-hemolytic streptococci; Penicillinas-producing staphylococci.

Contraindications Contraindicated in: Hypersensitivity to cephalosphorins. Serious hypersensitivity to penicillin. Use Cautiously in: Renal impair- ment History of GI disease, especially colitis Geriatric patients (consider age-related decrease in body mass, renal/hepatic/ cardiac function, concurrent medications and chronic disease states) Pregnancy or Lactation

Drug Study Classification Brand Name/Generic Name Mechanism of Action GENERIC NAME
Co-trimoxazole (trimethoprim sulfamethoxazole)

Dose/Frequency/Route Indications Contraindications Dose/Frequency/Route 500 mg/160 mg 1 tab BID for days Indications
Uncomplicated UTIs caused by susceptible strains of Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter species, and coagulasenegative Staphylococcus species, including S. Saprophyticus. Treatment of acute otitis media due to susceptible strains of S. Pneumoniae and Haemophilus influenzaein children. Unlabeled uses: With dapsone for treatment of initial episodes of Pneumocystis jiroveci (carinii) pneumonia in patients who can tolerate co-trimoxazole; treatment and prevention of travellers diarrhea.

Side Effects Adverse Effects

Rash Pruritus Fever Epigastric distress Nausea Vomiting

Nursing Interventions
Perform culture and sensitivity tests before beginning drug therapy. Protect the 200mg tablets from exposure to light. Arrange for regular, periodic blood counts during therapy. Discontinue drug and consult with physician if any significant reduction in any formed blood element occurs.

Brand Names
Septra (GSK), Bactrim (Roche)

Classification
Sulfonamide antibiotic

Mechanism of Action
Trimethoprim inhibits the synthesis of nucleic acids and proteins in susceptible bacteria; the bacterial enzyme involved in this reaction is more readily inhibited than the mammalian enzyme. Sulfamethoxazole acts as a false-substrate inhibitor of dihydropteroate synthetase. Sulfonamides such as sulfamethoxazole are analogues of p-aminobenzoic acid (PABA) and are competitive inhibitors of the enzyme; inhibiting the production of dihydropteroic acid.

Contraindications
Contraindicated with allergy to trimethoprim and sulfamethoxazole, pregnancy (teratogenic in pre-clinical studies), megaloblastic anemia due to folate deficiency. Use cautiously with hepatic or renal impairment, lactation.

Drug Study Classification Brand Name/Generic Name Mechanism of Action GENERIC NAME Celecoxib Brand Names Celebrex Classification central nervous system agent, analgesic, nsaid, cyclooxygenase-2 inhibitor, antipyretic Mechanism of Action Exhibits anti-inflammatory, analgesic,and antipyreticaction due to inhibitionof the enzymeCOX-2 Dose/Frequency/Route Indications Contraindications Dose/Frequency/Route 200mg 1 amp BID Indications Adjunctive treatment to decrease the number of adenomatous colorectal polyps in familial adenomatous polyposis Contraindications Hypersensitivity to drug, sulfonamides, or other NSAIDs Severe hepatic impairment History of asthma or urticaria Advanced renal disease Late pregnancy Breastfeeding Side Effects Adverse Effects CNS: dizziness, drowsiness , headache, insomnia, fatigue CV: peripheraledema EENT: ophthalmic effects, tinnitus, pharyngitis, rhinitis, sinusitis GI: nausea, diarrhea, constipation, abdominal pain, dyspepsia, flatulence, drymouth, GI bleeding GU: menorrhagia Hematologic: Decreased hemoglobin or hematocrit, eosinophilla Nursing Interventions Before: - Assess pts history of allergic reaction to the drug - Monitor complete blood count, electrolyte levels, creatinine clearance, and occult fecal blood test and liver function test results every 6 to 12months During:Instruct patient totake drug withfood or milk.- Teach patient to avoid aspirin andother NSAIDs (suchas ibuprofen andnaproxen)during therapy. After: Advise patient to immediately report bloody stools, blood in vomit, or signs or symptoms of liver damage(nausea, fatigue, lethargy, pruritus, yellowing of eyes or skin, tenderness on upper right side of abdomen, or flulike symptoms).