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Drug Study DRUG ORDER (Generic name, Dosage, Route, Frequency, etc.) Amphotericin B 0.15 cc + 1.35 cc D5W OD
PHARMACOLOGI C ACTION OF DRUG
INDICATIONS AND CONTRAINDICATIONS
ADVERSE EFFECTS OF THE DRUG
DESIRED ACTION ON THE CLIENT
NURSING RESPONSIBILITIES /PRECAUTIONS
Increased cell membrane permeability in susceptible organisms by binding sterols in fungal membrane; decreases potassium, sodium and nutrients in the cell
Indications: • Treatment of severe, possibly fatal fungal infections Contraindications: • Hypersensitivity • Severe bone marrow depression
CNS: headache, fever, chills, peripheral nerve pain, paresthesias, peripheral neuropathy, seizures, dizziness EENT: tinnitus, deafness, diplopia, blurred vision GI: nausea, vomiting, anorexia, diarrhea, cramps, hemorrhagic gastroenteritis, acute liver failure GU: hypokalemia, axotemia, hyposthenuria, renal tubular acidosis, nephrocalcinosis, permanent renal impairment, anuria, oliguria Blood: normochromic and normocytic anemia, thrombocytopenia, agranulocytosis, leucopenia, eosinophilia, hypokalemia, hyponatremia, hypomagnesemia Integumentary: burning, irritation, pain, necrosis at inj site with extravasation, flushing, dermatitis, skin
Treat fungal infection
Monitor VS q1530 min during first inf; note changes in pulse, BP. Monitor blood studies Monitor weight weekly; if weight increases 2lb/wk, edema is present; renal damage should be considered. Monitor for renal toxicity; increasing BUN and serum creatinine Monitor for hepatotoxicity; increasing AST, ALT, alkaline phophatase Monitor for allergic reaction Monitor for hypokalemia
sputum.rash MS: athralgia. palpitations GI: diarrhea. pain at inj site. including characteristics of wounds. elderly . myalgia. phlebitis. generalized pain. myoclonia CV: hypotension. hepatitis. somnolence. pruritus. glossitis Blood: eosinophilia. pseudomembraneous colitis. headache. weakness. neutropenia. seizures. lactation. Hct Integumentary: rash. dyspnea. weakness. renal disease. weight loss Meropenem 30 mg IV q12h Interferes with cell wall replication of susceptible organisms. hyperventilation Treat bacterial infection Precautions: • Pregnancy. urticaria. stool Complete C/S tests before beginning drug therapy Assess for allergic reactions. erythema at inj site RESP: chest discomfort. anaphylaxis Identify urine output Monitor blood studies Monitor electrolytes Assess bowel pattern daily Monitor for bleeding • • • • • • • • Precautions: • Pregnancy. renal disease. nausea. urine. osmotically unstable cell wall swells and bursts from osmotic pressure Indications: • For serious infections caused by gram-positive or gram-negative organisms Contraindications: • Hypersensitivity to meropenem or imipenem CNS: fever. vomiting. decreased Hgb. lactation • Assess patient for previous sensitivity reaction to carbapenems Assess patient for signs and symptoms of infection. dizziness.
chest pain. ascites • Assess patient for signs and symptoms of infection • Obtain C/S before beginning . sweating. paresthesias CV: orthstatic hypotension. hyperuricemia ENDO: hyperglycemia GI: nausea. hypovolemia. magnesium. dehydration.65 mg IV OD Acts on the ascending loop of Henle in the kidney. insomnia. anxiety. nocturia. dizziness. diarrhea. tinnitus. neurologic manifestations of hypocalcemia: personality changes. ascites Contraindications: • Hypersensitivity to sulfonamides • Anuria. agranulocytosis. infants. glycosuria HEMA: thrombocytopenia. cramps. water and some potassium Indications: • Edema in CHF. severe renal disease. GI. inhibiting reabsorption of electrolytes sodium and chloride. hypoagnesemia. blurred vision CV: Arrhythmias. vertigo. purpura. disturbances Monitor for manifestations of hyponatremia Monitor electrolytes Ciprofloxacin 7 mg IV q12h Bactericidal. weakness. pulmonary manifestation of hypokalemia: acidic urine. pancreatitis GU: polyuria. cardiac. vomiting. DM. pruritus. calcium. anorexia. polyuria and polydipsia Monitor for CNS. interferes with DNA replication in susceptible bacteria preventing cell Indications: • For the treatment of infections caused by susceptible gramnegative bacteria. leucopenia. electrolyte depletion CNS: headache. cirrhosis. neiurologic. CNS: Headache. nephritic syndrome. anemia INTEG: rash. hypochloremic alkalosis. cardiovascular. photosensitivity. depression. circulatory collapse EENT: loss of hearing. urticaria MS: cramps. Treat bacterial infections Precautions: • Pregnancy. ECG changes. ear pain. ear pain Monitor for renal. chloride. stiffness Increase patient’s urine output • • • • • Assess patient for tinnitus. causing excretion of sodium.Furosemide 0. somnolence. dry mouth. GI. reanl failure. hearing loss. blurred vision ELECTROLYTES: hypokalemia. decreased urine osmolality. integumentary. fatigue. lactation. fatigue.
3 mg + 4. urticaria. children. sore throat. epilepsy Pentoxifylline 1. renal disease. Hct Other: Fever. K. norfloxacin or other fluoroquinolones. malaise. S. S. stimulates prostacyclin production. keratopathy GI: Nausea. flulike symptoms. rash • • • • • • drug therapy Assess for anaphylaxis Identify urine output Monitor blood studies Monitor electrolytes Assess bowel pattern daily Monitor for bleeding Precautions: • Pregnancy. vomiting. vulgaris. epidermidis. children. hypotension. nausea. cerebral hemorrhage CNS: headache. ALT.reproduction. dry mouth. AST. hypotension. neutrophil count. aeruginosa. dysrhythmias.7 cc D5W OD x 6o VSP x 6 days Decreases blood viscosity. conjunctivitis GI: dyspepsia. eye pain. impaired renal function. hepatic disease . aureus. mirabilis. increased salivation. P. belching. increasing blood flow by increasing flexibility of RBCs. dyspnea EENT: blurred vision. dizziness CV: Angina. pregnancy. decreases fibrinogen concentration Indications: • Intermittent claudication related to chronic occlusive vascular disease • Sickle cell anemia Contraindications: • Hypersensitivity • Retinal. diarrhea. pneumoniae. thrist INTEG: rash. tremors. constipation. anorexia. including E. angina pectoris. cardiac disease. decreased WBC. coli. dry mouth. serum creatinine and alkaline phosphatase. confusion. group D streptococci Contraindications: • Allergy to ciprofloxacin. weight changes Decrease blood viscosity • • Monitor BP and respirations Assess for intermittent claudication Precautions: • Pregnancy. lactation. reduces platelet aggregation. abdominal pain Hematologic: Elevated BUN. earache. chest pain. P. pruritus. nasal congestion. M. lactation. P. palpiptations. vomiting. morganii. rettgeri. P. Citrobacter freundii. Enterobacter cloacae. brittle fingernails Other: epistaxis. anxiety. angina EENT: Dry eye.
abdominal pain. pruritus META: hypokalemia. potentiates the effects of GABA. respiration • monitor inj site for redness. pseudomembranous colitis GU: oliguria. or CNS: Transient. anxiolysis. proteinuria. seizures. constipation. sedation. hypersensitivity to cephalosporins. pulse. serum sickness Bactericidal effects for Methicillinresistant Staphylococ cus aureus • • • • • • • • • • Assess patient for previous sensitivity reaction to penicillins Assess patient for signs and symptoms of infection Obtain C&S before beginning drug therapy Assess for allergic reactions Identify urine output Monitor blood studies Monitor electrolytes Assess bowel pattern daily Monitor for bleeding Assess for overgrowth of infection Midazolam 0.15 mg IV qh Acts mainly at the limbic system and reticular formation. hematuria. lethargy. lactation. hallucinations. dizziness. fatigue. apathy. skin. insomnia.Piperacillintazobactam 70 mg IV q8h x 30 mins Interferes with cell wall replication of susceptible organisms. pain. hypernatremia SYST: anaphylaxis. increased bleeding time. mild drowsiness (initially). and amnesia prior to diagnostic. fever. depression. therapeutic. bone barrow depression INTEG: rash. osmotically unstable cell wall swells and bursts from osmotic pressure Indications: • Respiratory tract. anxiety. lethargy. vomiting. bone and joint infections • Infections from penicillinaseproducing staphylococci Contraindications: • Hypersensitivity. swelling • assess . diarrhea. Sedation Precautions: • Pregnancy. neonates CNS: headache. depression GI: nausea. lightheadedness. glomerulonephritis HEMA: anemia. an inhibitory Indications: • IV or IM: Sedation. renal insufficiency in children • monitor BP.
visual and auditory disturbances. ataxia. pyloric stenosis have been reported when used in first trimester. respiratory depression Precautions: • COPD. nausea. inguinal hernia. neonatal withdrawal syndrome reported in infants). CV collapse. crying. hepatic dysfunction. palpitations. slurred speech. nasal congestion CV: Bradycardia. anxiolytic and amnesia effects occur at doses below those needed to cause sedation. pruritus. diarrhea. dermatitis GI: Constipation. diplopia. debilitated. AST. nystagmus. vivid dreams. restlessness. mild paradoxical excitatory reactions (during first 2 wk of treatment). cardiac defects. acute alcoholic intoxication. psychoses. rigidity. edema Dermatologic: Urticaria. urinary retention. elevations of blood enzymes: LDH. psychomotor retardation. euphoria. depressed hearing. difficulty in swallowing. has little effect on cortical function. headache. jaundice GU: Incontinence. acute narrow-angle glaucoma. hypertension. tremor. CHF. salivation. disorientation. microcephaly. menstrual irregularities • anterograde amnesia assess for apnea. vomiting. neonates. anorexia. skin rash. neonates . extrapyramidal symptoms. coma. dysarthria. stupor. alkaline phosphatase. dry mouth. dystonia. delirium. nervousness. difficulty in concentration. chills. chronc renal failure. ALT. hypotension. shock. confusion. changes in libido.neurotransmitter. gastric disorders. pregnancy (cleft lip or palate. vertigo. • • • endoscopic procedures or surgery Induction of general anesthesia Continuous sedation of intubated and mechanically ventilated patients as a component of anesthesia or during treatment in the critical care setting Unlabeled uses: Treatment of epileptic seizure or refractory status epilepticus Contraindications: • hypersensitivity to benzodiazepines. tachycardia.
blood. blood dyscrasias Other: Phlebitis and thrombosis at IV injection sites. CHF. diaphoresis. be alert for decreasing urinary output . urine glucose while on long term therapy • monitor weight daily • monitor VS q4h • monitor I&O ratio. insomnia. dehydration. and redness after IM injection Vecuronium 0. necrotizing angiitis Endocrine: Growth retardation. cataracts. gynecomastia.Hematologic: Decreased Hct. psychosis. antagonizing action of acetylcholine.15 mg IV qh (defer MAP <26) Inhibits transmission of nerve impulses by binding with cholinergic receptor sites. euphoria. reversible cerebral atrophy in infants. such as rheumatoid arthritis. paresthesias. initiating many complex reactions that are responsible for its anti-inflammatory and immunosuppressiv e effects. skeletal muscle relaxation during mechanical ventilation Contraindications: • hypersensitivity CNS: skeletal muscle weakness INTEG: urticaria RESP: prolonged apnea. Indications: • Hypercalcemia associated with cancer • Short-term management of various inflammatory and allergic disorders. headaches. decreased Decrease inflammatio n Precautions: • cardiac disease. electrolyte imbalances. pregnancy. fever. vertigo. intracerebral hemorrhage. possible respiratory paralysis. pseudotumor cerebri.16 mg IV q6h x 6 doses Enters target cells and binds to specific receptors. increased IOP. dermatologic CNS: Seizures. pain. muscular disturbances. depression. wheezing SYST: anaphylaxis Skeletal muscle paralysis • • • • monitor for electrolyte imbalances monitor patient’s VS monitor patient’s recovery monitor allergic reactions Dexamethaso ne 0. glaucoma CV: Hypertension. no analgesic response Indications: • Facilitation of endotracheal intubation. mood swings. bronchospasm. burning. collagen diseases (SLE). neuromuscular disease • monitor potassium. flushing. hiccups.
increased blood sugar. myasthenia gravis. pancreatitis. DM. status asthmaticus. seizure disorders. or head injury Testing adrenocortical hyperfunction Unlabeled uses: Antiemetic for cisplatin-induced vomiting. acne. negative nitrogen balance. secondary adrenocortical and pituitary unresponsiveness GI: Peptic or esophageal ulcer. osteoporosis. spontaneous fractures Other: Impaired wound healing. pneumonia. ecchymoses. loss of muscle mass. erythroblastopenia Trichinosis with neurologic or myocardial involvement Cerebral edema associated with brain tumor. CHF. fungal. increased sweating. petechiae. diabetes mellitus. irregular menses Hematologic: Fluid and electrolyte disturbances. glycosuria. increased serum cholesterol. GI and GU infections • • assess infection assess mental status Precautions: • pregnancy. glaucoma. peptic ulcer. including TB. abdominal distention GU: Amenorrhea. . immunosuppression and masking of signs of infection. cushingoid state. activation of latent infections. lactation. decreased serum T3 and T4 levels Hypersensitivity: Anaphylactoid or hypersensitivity reactions Musculoskeletal: Muscle weakness. craniotomy. and viral eye infections.• • • • • • • • diseases (pemphigus). abscess. diagnosis of depression Respiratory inhalant: Control of bronchial asthma requiring corticosteroids in conjunction with other therapy Intranasal: Relief of symptoms of seasonal or perennial rhinitis that responds poorly to other treatments Ophthalmic carbohydrate tolerance. and autoimmune disorders Hematologic disorders: Thrombocytopenic purpura. steroid myopathy.osteop orosis. thin and fragile skin. ulcerative colitis. septic infection. renal disease.
leading to cell death. lower respiratory tract infections. CNS: Reversible hearing loss. hepatotoxicity Hypersensitivity: Allergic reactions ranging from rash to anaphylaxis Other: Superinfections • • • • • • • • Assess patient for signs and symptoms of infection Obtain C&S results before beginning therapy Assess for allergic reactions Identify urine output Monitor blood studies Monitor electrolytes Assess bowel pattern daily Assess for overgrowth of infection Precautions: • Pregnancy. allergy to any component of the preparation used. causing change in protein function. Legionella pneumophila • URIs.15 ml po q6h Bacteriostatic or bactericidal in susceptible bacteria. uncontrollable emotions. vaccinia and varicella. Listeria monocytogenes.preparations: Inflammation of the lid. lactation . conjunctiva. cornea. pseudomembranous colitis. vomiting. amebiasis. binds to cell membrane. Mycoplasma pneumoniae. anorexia. and antibiotic-resistant infections. confusion. and globe Contraindications: • infections. diarrhea. Indications: • Acute infections caused by sensitive strains of Streptococcus pneumoniae. abnormal thinking CV: Ventricular arrhythmias (with IV) GI: Abdominal cramping. fungal infections. skin and soft-tissue infections caused by group A betahemolytic streptococci when oral treatment is preferred to injectable benzathine penicillin • In conjunction with Erythromycin 125g/5ml 0. especially tuberculosis.
irregular menses.75 mg/tab ½ tab OD Competitively blocks the effects of aldosterone in the renal tubule. Indications: • Diagnosis and maintenance of primary hyperaldosteronis m • Adjunctive therapy in edema associated with CHF. headache. deepening of the voice. fatigue. ataxia. urticaria GI: Cramping. hyponatremia. vomiting. thirst. amenorrhea. Increased urine output • • • monitor for manifestations of hyperkalemia monitor for manifestations of hyponatermia Assess fluid volume status: I&O ratios. postmenopausal bleeding Hematologic: Hyperkalemia. hepatic disease. hirsutism. causing loss of sodium and water and retention of potassium. GU: Impotence. agranulocytosis Other: Carcinogenic in animals. drowsiness. diarrhea. hepatic cirrhosis when other therapies are inadequate or inappropriate • Treatment of hypokalemia or prevention of CNS: Dizziness. urine quality Monitor electrolytes • Precautions: • Dehydration.sulfonamides in URIs caused by Haemophilus influenzae • As an adjunct to antitoxin in infections caused by Corynebacterium diphtheriae and Corynebacterium minutissimum • Prophylaxis against alphahemolytic streptococcal endocarditis before dental or other procedures in patients allergic to penicillin who have valvular heart disease Contraindications: • Allergy to erythromycin Spironolactone 0. dry mouth. crackles in lung. confusion Dermatologic: Rash. . nephrotic syndrome.
headache. shortterm treatment of acne vulgaris gynecomastia lactation. insomnia. restlessness.• • hypokalemia in patients who would be at high risk if hypokalemia occurred: Digitalized patients. renal disease. anuria. seizures. Theophylline 1. palliation of symptoms of PMS. tremors CV: palpitations. dysrhythmias Breathe without difficulty • • • monitor theophylline blood levels monitor I&O assess for signs of toxicity: irritability. hypotension. treatment of familial male precocious puberty.4 mg po q12h Relaxes smooth muscle of respiratory system by blocking phosphodiesterase . renal disease. patients with cardiac arrhythmias Essential hypertension. usually in combination with other drugs Unlabeled uses: Treatment of hirsutism due to its antiandrogenic properties. dizziness. . sinus tachycardia. electrolyte imbalances Conraindications: • allergy to spironolactone. muscle twitching. which increases cAMP. amiloride or triamterene use. insomnia. which increases Indications: • Bronchospasm of COPD • Bronchial asthma • Chronic bronchitis Contraindications: • Hypersensitivity to CNS: anxiety. hyperkalemia.
gastric distress INTEG: flushing. cor pulmonale. hepatic disease. circulation. anorexia. diarrhea. CHF. hypertension • . urticaria RESP: increased rate • • restlessness. hyperthyroidism. rhythm and depth assess for allergic reactions • Precautions: • pregnancy. dieresis. bitter taste. elderly. hepatic disease. CNS stimulation • xanthines tachydysrhythmias ENDO: hyperglycemia GI: nausea.bronchodilation. vomiting. tremors monitor respiratory rate. DM.