MEDICATION: Captopril (Capoten) is an ACE inhibitor and a common antihypertensive.

Captopril works by competitively inhibiting the conversion of angiotensin I to angiotensin II. Generic Name Contents [hide] 1 Generic Name 2 Brand Names 3 Classification 4 Dosage & Route 5 Therapeutic actions 6 Pharmacokinetics 7 Indications 8 Adverse effects 9 Contraindications 10 Nursing Considerations o 10.1 Assessment o 10.2 Interventions o 10.3 Teaching points captopril Brand Names Apo-Capto (CAN),

Capoten, Gen-Captopril (CAN), Novo-Captopril (CAN),

Nu-Capto (CAN) Classification ACE inhibitor, Antihypertensive Pregnancy Category C (first trimester) Pregnancy Category D (second and third trimesters) Dosage & Route PO HTN Initial: 12.5 mg twice daily.

Maintenance: 25-50 mg twice daily. Max: 50 mg 3 times/day. Max: 50 mg 3 times/day. Initial: 6.25 mg/day, may increase after several wk to 150 mg/day in divided doses if needed and tolerated.

Heart failure Initial: 6.25-12.5 mg 2-3 times/day. Post MI Start 3 days after MI.

Diabetic nephropathy 25 mg 3 times/day.

Therapeutic actions Captopril competitively inhibits the conversion of angiotensin I (ATI) to angiotensin II (ATII), thus resulting in reduced ATII levels and aldosterone secretion. It also increases plasma renin activity and bradykinin levels. Reduction of ATII leads to decreased sodium and water retention. By these mechanisms, captopril produces a hypotensive effect and a beneficial effect in congestive heart failure. Pharmacokinetics Absorption: 60-75% absorbed from the GI tract (oral); peak plasma concentrations after 1 hr. Absorption may be reduced in the presence of food.

Distribution: Protein-binding: 30%; crosses the placenta and enters breast milk at about 1% of maternal blood concentrations.

Excretion: Via urine (40-50% as unchanged, the rest as disulfide and other metabolites); 2-3 hr (elimination half-life), may be increased in renal impairment. Removed by hemodialysis. Indications Treatment of hypertension alone or in combination with thiazide-type diuretics

Treatment of CHF in patients unresponsive to conventional therapy; used with diuretics and digitalis Treatment of diabetic nephropathy Treatment of left ventricular dysfunction after MI

Unlabeled uses: Management of hypertensive crises; treatment of rheumatoid arthritis; diagnosis of anatomic renal artery stenosis, hypertension related to scleroderma renal crisis; diagnosis of primary aldosteronism, idiopathic edema; Bartters syndrome; Raynauds syndrome Adverse effects Hypotension, tachycardia, chest pain, palpitations, pruritus, hyperkalemia. Proteinuria; angioedema, skin rashes; taste disturbance, nonproductive cough, headache. Potentially Fatal: Neutropenia, usually occurs within 3 mth of starting therapy especially in patients with renal dysfunction or collagen diseases. Hyperkalaemia. Anaphylactic reactions. Contraindications Known hypersensitivity to the drug.

Bilateral renal artery stenosis, hereditary angioedema; renal impairment;

pregnancy. Nursing Considerations Assessment History: Allergy to captopril, history of angioedema, impaired renal function, CHF, salt or volume depletion, pregnancy, lactation

Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal function tests, CBC and differential Interventions Administer 1 hr before meals.

WARNING: Ensure that patient is not pregnant before beginning treatment. Encourage use of contraceptives; if pregnancy is detected, stop drug. WARNING: Alert surgeon and mark patients chart with notice that captopril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion.

Monitor patient closely for fall in BP secondary to reduction in fluid volume (due to excessive perspiration, and dehydration, vomiting, or diarrhea); excessive hypotension may occur.

Reduce dosage in patients with impaired renal function. Teaching points Take drug 1 hour before meals; do not take with food. Do not stop without consulting your healthcare provider.

Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, or dehydration); if lightheadedness or dizziness occurs, consult your healthcare provider. Severe fetal damage can occur if captopril is taken during pregnancy. Use of contraceptives is advised; if pregnancy should occur, stop drug and notify health care provider. Avoid over-the-counter medications, especially cough, cold, allergy medications that may contain ingredients that will interact with ACE inhibitors. Consult your healthcare provider. You may experience these side effects: Cough, GI upset, loss of appetite, change in taste perception (limited effects, will pass); mouth sores (frequent mouth care may help); rash; fast heart rate; dizziness, light-headedness (usually passes after the first few days; change position slowly, and limit your activities to those that do not require alertness and precision). Report mouth sores; sore throat, fever, chills; swelling of the hands or feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips or tongue; difficulty breathing.

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Ranitidine (Zantac) Drug Study Posted by: Matt Vera in Drug Study January 21, 2012 Last updated on March 13th, 2012 0 119 Views

Brand Name: Apo-Ranitidine (CAN),

Generic Name : ranitidine hydrochloride

CO Ranitidine (CAN), Gen-Ranitidine (CAN), Novo-Ranitidine, (CAN), Nu-Ranit (CAN), ratio-Ranitidine (CAN), Zantac, Zantac EFFERdose, Zantac GELdose, Zantac 75, Zantac 150

Classification: Histamine2 (H2) antagonist

Pregnancy Category B Dosage & Route 1 Dosage & Route o 1.1 Adults o 1.2 Pediatric o 1.3 Geriatric Patients and Patients with Impaired Renal Function 2 Therapeutic actions 3 Indications 4 Adverse effects Contents [hide]

5 Contraindications 6 Nursing considerations o 6.1 Assessment o 6.2 Interventions o 6.3 Teaching points Available forms : Tablets75, 150, 300 mg; effervescent tablets and granules25, 150 mg; syrup15 mg/mL; injection1, 25 mg/mL Adults Active duodenal ulcer: 150 mg bid PO for 48 wk. Alternatively, 300 mg PO once daily at bedtime or 50 mg IM or IV q 68 hr or by intermittent IV infusion, diluted to 100 mL and infused over 1520 min. Do not exceed 400 mg/day.

Maintenance therapy, duodenal ulcer: 150 mg PO at bedtime. Active gastric ulcer: 150 mg bid PO or 50 mg IM or IV q 68 hr. Pathologic hypersecretory syndrome: 150 mg bid PO. Individualize dose with patients response. Do not exceed 6 g/day. GERD, esophagitis, benign gastric ulcer: 150 mg bid PO.

Treatment of heartburn, acid indigestion: 75 mg PO as needed. Pediatric Safety and efficacy not established. Geriatric Patients and Patients with Impaired Renal Function For creatinine clearance < 50 mL/min, accumulation may occur; use lowest dose possible, 150 mg q 24 hr PO or 50 mg IM or IV q 1824 hr. Dosing may be increased to q 12 hr if patient tolerates it and blood levels are monitored. Therapeutic actions Ranitidine blocks histamine H2-receptors in the stomach and prevents histaminemediated gastric acid secretion. It does not affect pepsin secretion, pentagastrinstimulated factor secretion or serum gastrin. Indications Short-term treatment of active duodenal ulcer

Maintenance therapy for duodenal ulcer at reduced dosage Short-term treatment of active, benign gastric ulcer Short-term treatment of GERD Pathologic hypersecretory conditions (eg, Zollinger-Ellison syndrome) Treatment of erosive esophagitis

Treatment of heartburn, acid indigestion, sour stomach Adverse effects Headache, dizziness. Rarely hepatitis, thrombocytopaenia, leucopaenia, hypersensitivity, confusion, gynecomastia, impotence, somnolence, vertigo, hallucinations.

Potentially Fatal: Anaphylaxis, hypersensitivity reactions. Contraindications Porphyria. Nursing considerations Assessment History: Allergy to ranitidine, impaired renal or hepatic function, lactation, pregnancy Physical: Skin lesions; orientation, affect; pulse, baseline ECG; liver evaluation, abdominal examination, normal output; CBC, LFTs, renal function tests Interventions Administer oral drug with meals and at bedtime.

Decrease doses in renal and liver failure. Provide concurrent antacid therapy to relieve pain. Administer IM dose undiluted, deep into large muscle group.

Arrange for regular follow-up, including blood tests, to evaluate effects. Teaching points Take drug with meals and at bedtime. Therapy may continue for 46 weeks or longer.

If you also are using an antacid, take it exactly as prescribed, being careful of the times of administration. Have regular medical follow-up care to evaluate your response. You may experience these side effects: Constipation or diarrhea (request aid from your health care provider); nausea, vomiting (take drug with meals); enlargement of breasts, impotence or decreased libido (reversible); headache (adjust lights and temperature and avoid noise). Report sore throat, fever, unusual bruising or bleeding, tarry stools, confusion, hallucinations, dizziness, severe headache, muscle or joint pain

Generic Name:Omeprazole(o-mepra-zole) Brand Name:Losec,Prilosec Classifications:gastrointestinal agent; proton pump inhibitor Pregnancy Category:C Availability: 10 mg, 20 mg, 40 mg capsules Actions An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid secretion by inhibiting the H+, K+-ATPase enzyme system [the acid (proton H+) pump] in the parietal cells.

Therapeutic effects Suppresses gastric acid secretion relieving gastrointestinal distress and promoting ulcer healing. Uses Duodenal and gastric ulcer. Gastroesophageal reflux disease including severe erosive esophagitis (4 to 8 wk treatment). Long-term treatment of pathologic hypersecretory conditions such as Zollinger-Ellison syndrome, multiple endocrine adenomas, and systemic mastocytosis. In combination with clarithromycin to treat duodenal ulcers associated with Helicobacter pylori. Contraindications Long-term use for gastroesophageal reflux disease, duodenal ulcers; lactation. Route & dosage Gastroesophageal Reflux, Erosive Esophagitis, Duodenal Ulcer adult: PO 20 mg once/d for 48 wk Gastric Ulcer adult: PO 20 mg b.i.d. for 48 wk Hypersecretory Disease adult:PO 60 mg once/d up to 120 mg t.i.d. Duodenal Ulcer Associated with H. pylori adult:PO 40 mg once/d for 14 d, then 20 mg/d for 14 d, in combination with clarithromycin 500 mg t.i.d. for 14 d Administration Oral Give before food, preferably breakfast; capsules must be swallowed whole (do not open, chew, or crush). Note: Antacids may be administered with omeprazole. Adverse effects CNS:Headache, dizziness, fatigue. GI:Diarrhea, abdominal pain, nausea, mild transient increases in liver function tests. Urogenital:Hematuria, proteinuria. Skin:Rash. Nursing implications Assessment & Drug Effects Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests with prolonged use. Patient & Family Education Report any changes in urinary elimination such as pain or discomfort associated with urination, or blood in urine. Report severe diarrhea; drug may need to be discontinued. Do not breast feed while taking this drug

Tranxemic acid Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin Classification: Anti-fibrinolytic, antihemorrhagic Indications: Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas: Treating heavy menstrual bleeding Hemorrhage following dental and/or oral surgery in patients with hemophilia Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures. Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues. Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage Effective in promoting hemostasis in traumatic injuries. Preventing hemorrhage after orthopedic surgeries. Mechanism of Action Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Anti-fibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogenplasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis. Contraindications 1. Allergic reaction to the drug or hypersensitivity 2. Presence of blood clots (eg, in the leg, lung, eye, brain), have a history of blood clots, or are at risk for blood clots 3. Current administration of factor IX complex concentrates or anti-inhibitor coagulant concentrates Precautions 1. Pregnancy. Tranexamic acid crosses the placenta. 2. Lactation. Tranexamic acid is distributed into breast milk; concentrations reach approximately 1% of the maternal plasma concentration. 3. Contraceptives, estrogen-containing, oral or Estrogens. Concurrent use with tranexamic acid may increase the potential for thrombus formation. 4. Renal function impairment (medication may accumulate; dosage adjustment based on the degree of impairment is recommended)

5. Hematuria of upper urinary tract origin (risk of intrarenal obstruction secondary to clot retention in the renal pelvis and ureters if hematuria is massive; also, if hematuria is associated with a disease of the renal parenchyma, intravascular precipitation of fibrin may occur and exacerbate the disease) Nursing Responsibilities 1. Unusual change in bleeding pattern should be immediately reported to the physician. 2. For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period. 3. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed. 4. The medication can be taken with or without meals. 5. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing. 6. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once. 7. Inform the client that he/she should inform the physician immediately if the following severe side effects occur: Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue Calf pain, swelling or tenderness Chest pain Confusion Coughing up blood Decreased urination Severe or persistent headache Severe or persistent body malaise Shortness of breath Slurred speech Slurred speech Vision changes clonidine hydrochloride Drug Name Generic Name : clonidine hydrochloride

Brand Name:

Antihypertensives: Apo-Clonidine (CAN), Catapres, Catapres-TTS (transdermal preparation), Dixarit (CAN), Duraclon, Novo-Clonidine (CAN), Nu-Clonidine (CAN) Analgesic: Duraclon

Classification: Antihypertensive, Sympatholytic (centrally acting), Central analgesic Pregnancy Category C

Dosage & Route Adults Oral therapy

Individualize dosage. Initial dose is 0.1 mg bid; for maintenance dosage, increase in increments of 0.1 or 0.2 mg to reach desired response. Common range is 0.20.6 mg/day, in divided doses; maximum dose is 2.4 mg/day. Minimize sedation by slowly increasing daily dosage; giving majority of daily dose at bedtime.

Transdermal system

Apply to a hairless area of intact skin of upper arm or torso once every 7 days. Change skin site for each application. If system loosens while wearing, apply adhesive overlay directly over the system to ensure adhesion. Start with the 0.1-mg system (releases 0.1 mg/24 hr); if, after 12 wk, desired BP reduction is not achieved, add another 0.1-mg system, or use a larger system. Dosage of more than two 0.3-mg systems does not improve efficacy. Antihypertensive effect may only begin 23 days after application; therefore, when substituting transdermal systems, a gradual reduction of prior dosage is advised. Remove old system before applying new one. Previous antihypertensive medication may have to be continued, particularly with severe hypertension.

Epidural injection

Pain management: 30 mcg/hr by continuous epidural infusion.

Pediatric Patients

Safety and efficacy not established.

Therapeutic actions

 Clonidine stimulates alpha-2 receptors in brain stem which results in reduced sympathetic outflow from the CNS and a decrease in peripheral resistance leading to reduced BP and pulse rate. It does not alter normal hemodynamic response to exercise at recommended dosages.

Indications

Hypertension, used alone or as part of combination therapy Treatment of severe pain in cancer patients in combination with opiates; epidural more effective with neuropathic pain (Duraclon) Unlabeled uses: Tourette's syndrome; migraine, decreases severity and frequency; menopausal flushing, decreases severity and frequency of episodes; chronic methadone detoxification; rapid opiate detoxification (in doses up to 17 mcg/kg/day); alcohol and benzodiazepine withdrawal treatment; management of hypertensive "urgencies"; (oral clonidine "loading" is used; initial dose of 0.2 mg then 0.1 mg every hour until a dose of 0.7 mg is reached or until BP is controlled)

Adverse effects

Dry mouth, drowsiness, dizziness, headache, constipation, impotence, vivid dreams, urinary retention; dry, itching, burning sensation in the eye; fluid or electrolyte imbalance, GI upset, paralytic ileus, orthostatic hypotension, weakness, sedation, pruritus, myalgia, urticaria, nausea, insomnia, arrhythmias, agitation. Reduced GI motility at times may cause paralytic ileus. Potentially Fatal: Transient hypertension or profound hypotension, respiratory depression, convulsion. Clonidine withdrawal syndrome could be life threatening. Bradycardia, coma and disturbances in conduction (in individuals with preexisting diseases of SA/AV nodes, overdose or on digitalis).

Contraindications

Hypersensitivity. Disorders of cardiac pacemaker activity and conduction. Pregnancy and lactation.

Nursing considerations CLINICAL ALERT!

Name confusion has occurred between clonidine and Klonopin (clonazepam); use caution.

Assessment

History: Hypersensitivity to clonidine or adhesive layer components of the transdermal system; severe coronary insufficiency, recent MI, cerebrovascular disease; chronic renal failure; lactation, pregnancy

Physical: Body weight; T; skin color, lesions, T; mucous membranes color, lesions; breast examination; orientation, affect, reflexes; ophthalmologic examination; P, BP, orthostatic BP, perfusion, edema, auscultation; bowel sounds, normal output, liver evaluation, palpation of salivary glands; normal urinary output, voiding pattern; LFTs, ECG

Interventions

WARNING: Do not discontinue abruptly; discontinue therapy by reducing the dosage gradually over 24 days to avoid rebound hypertension, tachycardia, flushing, nausea, vomiting, cardiac arrhythmias (hypertensive encephalopathy and death have occurred after abrupt cessation of clonidine). Do not discontinue transdermal therapy prior to surgery; monitor BP carefully during surgery; have other BP-controlling drugs readily available. Continue oral clonidine therapy within 4 hr of surgery then resume as soon as possible thereafter. Store epidural injection at room temperature; discard any unused portions. Reevaluate therapy if clonidine tolerance occurs; giving concomitant diuretic increases the antihypertensive efficacy of clonidine. Monitor BP carefully when discontinuing clonidine; hypertension usually returns within 48 hr. WARNING: Remove transdermal patch before defibrillation to prevent arcing. Assess compliance with drug regimen in a supportive manner with pill counts, or other methods.

Teaching points

Take this drug exactly as prescribed. Do not miss doses. Do not discontinue the drug unless instructed by your health care provider. Do not discontinue abruptly; life-threatening adverse effects may occur. If you travel, take an adequate supply of drug. Use the transdermal system as prescribed; refer to directions in package insert, or contact your health care provider with questions. Be sure to remove old systems before applying new ones. Attempt lifestyle changes that will reduce your blood pressure: Stop smoking and using alcohol; lose weight; restrict intake of salt; exercise regularly. Use caution with alcohol. Your sensitivity may increase while using this drug. You may experience these side effects: Drowsiness, dizziness, light-headedness, headache, weakness (often transient; observe caution driving or performing other tasks that require alertness or physical dexterity); dry mouth (sucking on sugarless lozenges or ice chips may help); GI upset (eat frequent small meals); dreams, nightmares (reversible); dizziness, light-headedness when you change position (get up slowly; use caution climbing stairs); impotence, other sexual dysfunction, decreased libido (discuss with your health care provider); breast enlargement, sore breasts; palpitations. Report urinary retention, changes in vision, blanching of fingers, rash

GENERIC NAME: ciprofloxacin BRAND NAME: Cipro, Cipro XR, Proquin XR

DRUG CLASS AND MECHANISM: Ciprofloxacin is an antibiotic that is used to treat bacterial infections. Ciprofloxacin belongs to the fluoroquinolone class of antibiotics which includes levofloxacin (Levaquin), ofloxacin (Floxin),gatifloxacin (Tequin), norfloxacin (No roxin), moxifloxacin (Avelox),trovafloxacin (Trovan) and others. Ciprofloxacin stops the multiplication of bacteria by inhibiting the reproduction and repair of their genetic material (DNA). The FDA approved ciprofloxacin in October 1987. PRESCRIPTION: Yes GENERIC AVAILABLE: Yes PREPARATIONS: Tablets: 250, 500, and 750 mg. Tablets extended release (XR): 500 and 1000 mg. Microcapsules for suspension: 250 mg/5 ml, 500 mg/5 ml. Injection or Injection concentrate: 200 and 400 mg. STORAGE: Immediate release tablets: store below 30C (86F). Extended release tablets: store between 15-30C (59-86F). Microcapsules: store below 25C (77F) and protect from freezing. Injection: Store between 5-30C (41-86F) and avoid freezing. PRESCRIBED FOR: Ciprofloxacin is used to treat infections of the skin, lungs, airways, bones, and joints caused by susceptible bacteria. Ciprofloxacin is also frequently used to treat urinary infections caused by bacteria such as E. coli. Ciprofloxacin is effective in treating infectious diarrheas caused by E. coli, Campylobacter jejuni, and Shigella bacteria. DOSING: For most infections the recommended oral dose for adults is 250-750 mg (immediate release tablets) every 12 hours or 500-1000 mg (extended release tablets) every 24 hours. The usual intravenous dose is 200-400 mg every 8-12 hours. DRUG INTERACTIONS: Ciprofloxacin administered together withtheophylline can lead to elevated, toxic blood levels of theophylline. Theophylline is used to open airways in the treatment of asthma. Toxic levels of theophylline can lead to seizures, and disturbances in heart rhythm. If concurrent use of ciprofloxacin and theophylline cannot be avoided, frequent blood tests to monitor theophylline blood levels are recommended. Iron salts (for example, ferrous sulfate) may reduce the absorption of ciprofloxacin because of formation of a ciprofloxacin-iron complex that is not absorbable. Antacids also may reduce the absorption of ciprofloxacin. If patients are receiving iron salts or antacids and ciprofloxacin, the ciprofloxacin should be given two hours before or six ours after the iron salt or antacid. Ciprofloxacin may increase the blood thinning effect of warfarin (Coumadin). The reason for this is unknown. Anticoagulant activity should be monitored after starting or stopping ciprofloxacin. Sevelamer (Renagel) may reduce the absorption of ciprofloxacin and possibly reduce the effectiveness of ciprofloxacin. Milk and orange juice also may reduce the absorption

of ciprofloxacin. Ciprofloxacin, as with iron and antacids, should be given two hours before or six ours after milk or orange juice. PREGNANCY: Ciprofloxacin should be avoided in pregnancy, as safe use in pregnant women has not been established. NURSING MOTHERS: Ciprofloxacin should be avoided in nursing mothers, as safe use in pregnant women has not been established. SIDE EFFECTS: The most frequent side effects of ciprofloxacin includenausea, vomiting, diarrhea, abdominal pain, rash, headache, and restlessness. Rare allergic reactions have been described, such as hivesand anaphylaxis (shock). Ciprofloxacin should be used with caution in patients with central nervous system diseases such as seizures, because rare seizures have been reported in patients receiving ciprofloxacin. Ciprofloxacin should be avoided in children and adolescents less than 18 years of age, as safe use in these patients has not been established.

Many antibiotics, including ciprofloxacin, can alter the normal bacteria in the colon and encourage overgrowth of a bacterium responsible for the development of inflammation of the colon (pseudomembranous colitis). Patients who develop signs of pseudomembranous colitis after starting ciprofloxacin (diarrhea, fever, abdominal pain, and possibly shock) should contact their physician. Patients taking ciprofloxacin can develop sensitivity of the skin to direct sunlight (photosensitivity) and should avoid exposure to sunlight or use sun protection and sunscreens. Ciprofloxacin as well as other antibiotics in the fluoroquinolone class of antibiotics, has been associated with tendinitis and even rupture of tendons, particularly the Achilles tendon. Some physicians recommend that their patients discontinue vigorous exercise while they are taking fluoroquinolone antibiotics. USES: This medication is used to treat a variety of bacterial infections. Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. It works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for virus infections (e.g., common cold, flu). Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness. HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using ciprofloxacin and each time you get a refill. If you have any questions, consult your doctor or pharmacist.This medication may be taken with or without food, usually twice a day in the morning and evening or as directed by your doctor.The dosage and length of treatment is based on your medical condition and response to treatment. Drink plenty of fluids while taking this medication unless your doctor tells you otherwise.Take this medication at least 2 hours before or 6 hours after taking other products that may bind to it, decreasing its effectiveness. Ask your pharmacist about the

other products you take. Some examples include:quinapril, vitamins/minerals (including iron and zinc supplements), and products containing magnesium, aluminum, or calcium (such as antacids,didanosine solution, calcium supplements).Calcium-rich foods, including dairy products (such as milk, yogurt) or calcium-enriched juice, can also decrease the effect of this medication. Take this medication at least 2 hours before or 6 hours after eating calcium-rich foods, unless you are eating these foods as part of a larger meal that contains other (non-calcium-rich) foods. These other foods decrease the calcium binding effect.Ask your doctor or pharmacist about safely using nutritional supplements/replacements with this medication.Antibiotics work best when the amount of medicine in your body is kept at a constant level. It is important not to miss a dose. To help you remember and to keep the drug at a constant level, take it at the same times every day.Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.Tell your doctor if your condition persists or worsens. SIDE EFFECTS: See also Warning section.Nausea, diarrhea, dizziness, lightheadedness, headache, or trouble sleeping may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor immediately if any of these unlikely but serious side effects occur: skin that sunburns more easily (sun sensitivity).Ciprofloxacin may rarely cause serious nerve problems that may be reversible if identified and treated early. Seek immediate medical attention if you develop any of the following symptoms: pain/numbness/burning/tingling/weakness in any part of the body, changes in how you sense touch/pain/temperature/body position/vibration.Tell your doctor immediately if any of these rare but very serious side effects occur: unusual bruising/bleeding, signs of a new infection (e.g., new/persistent fever, persistent sore throat), unusual change in the amount of urine, change in color of urine (red/pink urine), signs ofliver problems (e.g., unusual tiredness, stomach/abdominal pain, persistent nausea/vomiting, yellowing eyes/skin, dark urine).Seek immediate medical attention if any of these rare but very serious side effects occur: severe/persistent headache, vision changes, shaking (tremors), seizures, severe dizziness, fainting, fast/irregular heartbeat, mental/mood changes (e.g., anxiety, confusion, hallucinations, depression, rare thoughts ofsuicide).This medication may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a type of resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Do not use anti-diarrhea products or narcotic pain medications if you have any of the following symptoms because these products may make them worse. Tell your doctor immediately if you develop: persistent diarrhea, abdominal or stomach pain/cramping, blood/mucus

in your stool.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects PRECAUTIONS: Before taking ciprofloxacin, tell your doctor or pharmacist if you are allergic to it; or to other quinolone antibiotics such as norfloxacin, gemifloxacin, levofloxacin, moxifloxacin, or ofloxacin; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: diabetes, heart problems (e.g., recent heart attack), joint/tendon problems (e.g., tendonitis, bursitis), kidney disease,liver disease, myasthenia gravis, nervous system disorder (e.g., peripheral neuropathy), seizure disorder, conditions that increase your risk of seizures (e.g., brain/head injury, brain tumors, cerebral atherosclerosis).Ciprofloxacin may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can infrequently result in serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that require immediate medical attention. The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may affect the heart rhythm (see also Drug Interactions section). Before using ciprofloxacin, tell your doctor or pharmacist if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using ciprofloxacin safely.This medication may rarely cause serious changes in blood sugar levels, especially if you have diabetes. Watch for symptoms of high blood sugar including increased thirst and urination. Also watch for symptoms of low blood sugar such as nervousness, shakiness, fast heartbeat, sweating, or hunger. Check your blood sugar regularly as directed by your doctor and report any changes. If you experience symptoms of low blood sugar, you may raise your blood sugar by using glucose tablets/gel or eating a quick source of sugar such as table sugar, honey, or candy, or drink fruit juice or non-diet soda. Tell your doctor immediately about the reaction and the use of this product. To help prevent low blood sugar, eat meals on a regular schedule, and do not skip meals.This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can

perform such activities safely. Limit alcoholic beverages.This medication may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths, and sunlamps. Use a sunscreen and wear protective clothing when outdoors.Caution is advised when using this drug in children because they may be more sensitive to its possible side effects (e.g., joint/tendon problems). Discuss the risks and benefits with the doctor.Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, older adults may be more sensitive to its side effects such as tendon problems (especially if they are also taking corticosteroids such as prednisone or hydrocortisone) or heart problems. Discuss the risks and benefits with your doctor.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk. Consult your doctor before breast-feeding.

amlodipine (amlo e' di peen) Norvasc Pregnancy Category C Drug classes Calcium channel-blocker Antianginal drug Antihypertensive Therapeutic actions Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells; inhibits transmembrane calcium flow, which results in the depression of impulse formation in specialized cardiac pacemaker cells, slowing of the velocity of conduction of the cardiac impulse, depression of myocardial contractility, and dilation of coronary arteries and arterioles and peripheral arterioles; these effects lead to decreased cardiac work, decreased cardiac oxygen consumption, and in patients with vasospastic (Prinzmetal's) angina, increased delivery of oxygen to cardiac cells. Indications \u2022 Angina pectoris due to coronary artery spasm (Prinzmetal's variant angina) \u2022

Chronic stable angina, alone or in combination with other agents \u2022 Essential hypertension, alone or in combination with other antihypertensives Contraindications and cautions \u2022 Contraindicated with allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block (second or third degree), lactation. \u2022 Use cautiously with CHF, pregnancy. Available forms Tablets\u20142.5, 5, 10 mg Dosages ADULTS Initially, 5 mg PO daily; dosage may be gradually increased over 10\u201314 days to a maximum dose of 10 mg PO daily. PEDIATRIC PATIENTS Safety and efficacy not established. GERIATRIC PATIENTS OR PATIENTS WITH HEPATIC IMPAIRMENT Initially, 2.5 mg PO daily; dosage may be gradually adjusted over 7\u201314 days based on clinical assessment. Pharmacokinetics Route Onset Peak Oral Unknown 6\u201312 hr Metabolism: Hepatic; T1/2: 3050 hr Distribution: Crosses placenta; may enter breast milk Excretion:Urine Adverse effects CNS: Dizziness, light-headedness, headache,asthenia, fatigue, lethargy C V:Peripheral edema,arrhyt hmias Dermatologic:Flushing,rash GI:Nausea, abdominal discomfort Interactions Drug-drug Possible increased serum levels and toxicity of cyclosporine if taken concurrently Nursing considerations

Assessment History: Allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block, lactation, CHF Physical: Skin lesions, color, edema; P, BP, baseline ECG, peripheral perfusion, auscultation; R, adventitious sounds; liver evaluation, GI normal output; liver and renal function tests, urinalysis Interventions Monitor patient carefully (BP, cardiac rhythm, and output) while adjusting drug to therapeutic dose; use special caution if patient has CHF. Monitor BP very carefully if patient is also on nitrates. Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy. Administer drug without regard to meals. Teaching points Take with meals if upset stomach occurs. These side effects may occur: Nausea, vomiting (eat small, frequent meals); headache (adjust lighting, noise, and temperature; medication may be ordered). Report irregular heartbeat, shortness of breath, swelling of the hands or feet, pronounced dizziness, constipation.

Brand Name: Mucosta Generic Name: Rebamipide Drug Classification: Antacid Indication: Peptic ulcer, Gastritis, Mechanism of Action: Rebamipide is a mucosal protective agent and is postulated to increase gastric blood flow,prostaglandin biosynthesis and decrease free oxygen radicals. Contraindication: Lactation

Adverse Reaction: Rash, pruritus, constipation, diarrhoea, nausea. Nursing Responsiblities: y Monitor for any adverse reaction

NURSING DIAGNOSIS: Fluid Volume, risk for deficientRisk factors may include Excessive losses through normal routes (severe frequent diarrhea, vomiting)Hypermetabolic state (inflammation, fever)Restricted intake (nausea/anorexia) Possibly evidenced by [Not applicable; presence of signs and symptoms establishes an actual diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIAPATIENT WILL:Hydration (NOC) Maintain adequate fluid volume as evidenced by moist mucous membranes,good skin turgor, and capillaryrefill; stable vital signs; balanced I&O with urine of normal concentration/amount.ACTIONS/INTERVENTIONS Fluid/Electrolyte Management (NIC)Independent Monitor I&O. Note number, character, andamount of stools; estimate insensible fluid losses,e.g., diaphoresis.Measure urine specific gravity; observe for oliguria.Assess vital signs (BP, pulse,temperature).Observe for excessively dry skin andmucous membranes,decreased skin turgor, slowed capillaryrefill.Weighdaily.Maintain oral restrictions, bedrest; avoidexertion.Observe for overt bleeding and test stooldaily for occultblood.RATIONALEProvides information about overall fluidbalance, renalfunction, and bowel disease control, aswell as guidelinesfor fluid replacement.Hypotension (including postural),tachycardia, fever canindicate response to and/or effect of fluidloss.Indicates excessive fluid loss/resultantdehydration.Indicator of overall fluid and nutritionalstatus.Colon is placed at rest for healing and todecreaseintestinal fluid losses.Inadequate diet and decreased absorptionmay lead tovitamin K deficiency and defects incoagulation,potentiating risk of hemorrhage. 27

Note generalized muscle weakness or cardiacdysrhythmias. Collaborative Administer parenteral fluids, bloodtransfusions asindicated.Administer medications as indicated:Antidiarrheal (Refer to ND: Diarrhea);Excessive intestinal loss may lead toelectrolyteimbalance, e.g., potassium, which isnecessary for proper skeletal and cardiac muscle function.Minor alterations inserum levels can result in profound and/or lifethreateningsymptoms.Reduces fluid losses from intestines. NURSING DIAGNOSIS: Pain, acuteMay be related to the effect of gastric acid secretion on damaged tissue Possibly evidenced by

Reports of colicky/cramping abdominal pain/referred painGuarding/distraction behaviors, restlessnessFacial mask of pain; self-focusing DESIRED OUTCOMES/EVALUATION CRITERIAPATIENT WILL:Pain Level (NOC) Report pain is relieved/controlled.Appear relaxed and able to sleep/rest appropriately.ACTIONS/INTERVENTIONS Pain Management (NIC)Independent Encourage patient to report pain.Assess reports of abdominal cramping or pain, notinglocation, duration, intensity (010 scale).Investigate andreport changes in pain characteristics.Note nonverbal cues, e.g., restlessness,reluctance tomove, abdominal guarding, withdrawal,RATIONALEMay try to tolerate pain rather than requestanalgesics.Colicky intermittent pain occurs withCrohns diseasePredefecation pain frequently occurs in UCwith urgency,which may be severe and continuous.Changes in paincharacteristics may indicate spread of disease/developingcomplications, e.g., bladder fistula,perforation, toxicmegacolon. 28

and depression.Investigate discrepancies between verbaland nonverbalcues.Review factors that aggravate or alleviatepain.Encourage patient to assume position of comfort, e.g.,knees flexed.Provide comfort measures (e.g., back rub,reposition) anddiversional activities.Observe/record abdominal distension,increasedtemperature, decreased BP. Collaborative Implement prescribed dietarymodifications, e.g.,commence with liquids and increase tosolid foods astolerated.Administer medications as indicated, e.g.:Analgesics;Anti-ulscer drugs;Body language/nonverbal cues may beboth physiologicaland psychological and may be used inconjunction withverbal cues to determine extent/severity of the problem.May pinpoint precipitating or aggravatingfactors (such asstressful events, food intolerance) or identify

developingcomplications.Reduces abdominal tension and promotessense of control.Promotes relaxation, refocuses attention,and mayenhance coping abilities.May indicate developing intestinalobstruction frominflammation, edema, and scarring.Complete bowel rest can reduce pain,cramping.Pain varies from mild to severe andnecessitatesmanagement to facilitate adequate restand recovery. Note: Opiates should be used with cautionbecause theymay precipitate toxic megacolon.Relieve spasms of GI tract and resultantcolicky pain. 29

diphenhydramine hydrochloride
DRUG NAME
Generic Name : diphenhydramine hydrochloride

Brand Name:

Oral: Allerdryl (CAN), AllerMax Caplets, Banophen, Banophen Allergy, Benadryl Allergy, Diphen AF, Diphenhist, Diphenhist Captabs, Genahist, Siladryl, Silphen Cough Oral prescription preparations: Benadryl, Tusstat Parenteral preparations: Benadryl

Classification: Antihistamine, Anti-motion sickness drug, Sedative-hypnotic, Antiparkinsonian, Cough suppressant Pregnancy Category B

DOSAGE & ROUTE ADULTS Oral

2550 mg q 48 hr PO. Motion sickness: Give full dose prophylactically 30 min before exposure to motion, and repeat before meals and at bedtime.

Nighttime sleep aid: 2550 mg PO at bedtime. Cough suppression: 25 mg q 4 hr PO, not to exceed 150 mg in 24 hr.

Parenteral

1050 mg IV or deep IM or up to 100 mg if required. Maximum daily dose is 400 mg.

PEDIATRIC PATIENTS > 10 KG OR 20 LB Oral

12.525 mg tidqid PO or 5 mg/kg/day PO or 150 mg/m2 per day PO. Maximum daily dose 300 mg. Motion sickness: Give full dose prophylactically 30 min before exposure to motion and repeat before meals and at bedtime. Cough suppression: o 26 yr: 6.25 mg q 4 hr, not to exceed 25 mg in 24 hr. o 612 yr: 12.5 mg q 4 hr PO, not to exceed 75 mg in 24 hr.

Parenteral

5 mg/kg/day or 150 mg/m2 per day IV or by deep IM injection. Maximum daily dose is 300 mg divided into four doses.

GERIATRIC PATIENTS

More likely to cause dizziness, sedation, syncope, toxic confusional states, and hypotension in elderly patients; use with caution.

THERAPEUTIC ACTIONS

Diphenhydramine blocks histamine H1-receptors on effector cells of the GI tract, blood vessels and respiratory tract. It also causes sedation and has some anticholinergic action.

INDICATIONS

Relief of symptoms associated with perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis; mild, uncomplicated urticaria and angioedema; amelioration of allergic reactions to blood or plasma; dermatographism; adjunctive therapy in anaphylactic reactions Active and prophylactic treatment of motion sickness Nighttime sleep aid Parkinsonism (including drug-induced parkinsonism and extrapyramidal reactions), in the elderly intolerant of more potent drugs, for milder forms of the disorder in other age groups, and in

combination with centrally acting anticholinergic antiparkinsonian drugs Syrup formulation: Suppression of cough due to colds or allergy

ADVERSE EFFECTS

CNS depression, dizziness, headache, sedation; paradoxical stimulation in children; dryness of mouth, thickened respiratory secretion, blurring of vision, urinary retention; GI disturbances; blood dyscrasias.

CONTRAINDICATIONS

Hypersensitivity ; neonates, lactation.

NURSING CONSIDERATIONS Assessment

History: Allergy to any antihistamines, narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction, third trimester of pregnancy, lactation Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision examination; P, BP; R, adventitious sounds; bowel sounds; prostate palpation; CBC with differential

Interventions

Administer with food if GI upset occurs. Administer syrup form if patient is unable to take tablets. Monitor patient response, and arrange for adjustment of dosage to lowest possible effective dose.

Teaching points

Take as prescribed; avoid excessive dosage. Take with food if GI upset occurs. Avoid alcohol; serious sedation could occur. These side effects may occur: Dizziness, sedation, drowsiness (use caution driving or performing tasks requiring alertness); epigastric distress, diarrhea or constipation (take drug with meals); dry mouth (use frequent mouth care, suck sugarless lozenges); thickening of bronchial secretions, dryness of nasal mucosa (use a humidifier). Report difficulty breathing, hallucinations, tremors, loss of coordination, unusual bleeding or bruising,

visual disturbances, irregular heartbeat.

GENERIC NAME: CLONIDINE - ORAL (KLON-i-deen)

BRAND NAME(S): Catapres

Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes |Missed Dose | Storage USES: This medication is used alone or with other medications to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Clonidine belongs to a class of drugs (central alpha agonists) that act in the brain to lower blood pressure. It works by relaxing blood vessels so blood can flow more easily.OTHER This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.This drug may also be used for attention deficit hyperactivity disorder (ADHD), for hot flashes that occur with menopause, for withdrawal symptoms from narcotic drugs, and to help people quit smoking. HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually twice daily (in the morning and at bedtime). If the doses are not equal, take the larger dose at bedtime to decrease the risk of side effects.The dosage is based on your medical condition and response to treatment.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.Do not stop taking this medication without consulting your doctor. You may experience symptoms such as nervousness, agitation, shaking, and headache. A rapid rise in blood pressure may also occur if the drug is suddenly stopped. The risk is greater if you have used this drug for a long time or in high doses, or if you are also taking a beta blocker (such as atenolol). There have also been rare reports of severe, possibly fatal reactions (such as stroke) from stopping this drug too quickly. Therefore, it is important that you do not run out of clonidine or miss any doses. Tell your doctor or pharmacist immediately if you are unable to take the medication (for example, due to vomiting). To prevent any reactions while you are stopping treatment with this drug, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details. Report any new or worsening symptoms immediately.When used for a long time, this medication may not work as well and may require different dosing or an additional medication. Talk with your doctor if this medication stops working well (such as your blood pressure readings remain high or increase). SIDE EFFECTS: Dizziness, lightheadedness, drowsiness, dry mouth, orconstipation may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.Remember that your doctor has prescribed this medication because he or she has

judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, slow heartbeat, mental/mood changes (such as irritability, depression).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash,itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA1088.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

. Centrally Acting Adrenergic Inhibitors clonidine hydrochloride (Catapres) 1. Nursing Management a. Assessment 1. Use with caution in CAD, CVA, CRF, Raynaud's disease or history of depression 2. Watch for orthostatic hypotension especially in elderly. 3. Transdermal dosage form - assess skin b. Implementation 1. Monitoring a. Monitor B/P closely b. Weight daily 3-4 days as Na++/H2O retention may be a problem. 2. Intervention a. Patch - reapply q 7 days - do not trim, remains in place when bathing or showering b. Do not stop abruptly - rebound hypertension c. Education 1. Stress importance of follow-up visits 2. Discuss abrupt withdrawal including sequential doses - HTN crisis can occur in 8-24 hours 3. Instruct client to take last dose before bedtime to ensure continuous blood pressure control during night and reduce daytime drowsiness if taking oral form of drug. 4. Avoid alcohol, prolonged standing, and exercising.

5. Side effects - dry mouth, constipation, impotence, drowsiness, withdrawal phenomena 6. Periodic eye examinations to avoid possible retinal degeneration d. Evaluation 1. Monitor for drug tolerance 2. Blod pressure will stay within normal limits.
DIPHENHYDRAMINE Ther. Class. allergy, cold and cough remedies antihistamines antitussives

Indications o o o
Relief of allergic symptoms caused by histamine release including: Anaphylaxis, Seasonal and perennial allergic rhinitis, Allergic dermatoses. Parkinson's disease and dystonic reactions from medications. Mild nighttime sedation. Prevention of motion sickness. Antitussive (syrup only).

Action
Antagonizes the effects of histamine at H1-receptor sites; does not bind to or inactivate histamine. Significant CNS depressant and anticholinergic properties.

Diphenhydramine is an antihistamine used in psychiatric medicine to treat phenothiazine drug-induced abnormal muscle movement. It is also used in general medicine to treat allergies, allergic reactions, motion sickness, insomnia , cough, and nausea. When diphenhydramine is used for allergy-related symptoms, it is sold in the United States as an over-the-counter medication Benadryl. For use in the treatment of the tremors caused by phenothiazines, diphenhydramine is prescribed in the generic form.

Purpose
Some drugs called phenothiazines are used to treat psychotic disorder such as schizophrenia . As a side effect, these drugs may cause tremors and abnormal

involuntary movements of the muscles, referred to as extrapyramidal neurologic movement disorders . Diphenhydramine is used to control these symptoms. Other uses of the drug include the treatment of nausea, vomiting, and itching. Diphenhydramine is used to help limit allergic reactions to transfused blood products. It can induce sleep. It is sometimes used to treat the stiffness and tremor of Parkinson's disease. In liquid form, it may relieve minor throat irritation.

Description
Diphenhydramine is an antihistamine that is readily distributed throughout the body. It is easily absorbed when taken by mouth. Maximal action occurs approximately one hour after swallowing the drug. The effects continue for four to six hours. Diphenhydramine acts on cells in the brain . It seems to compete with the chemical histamine for specific receptor sites on cells in the brain and central nervous system. This means that it achieves its theraputic effect by taking the place of the neurotransmitter histamine on these cells. Diphenhydramine is a useful medication for individuals with mild Parkinsonism when it is used in combination with centrally acting anticholinergic drugs.

Recommended dosage
The dosage of diphenhydramine must be adjusted according to the needs of individuals and their responses. Adults are generally given 2550 mg orally, three to four times daily. Diphenhydramine may be administered through a vein or injected deep within a muscle. The usual dosage is 1050 mg per injection, although some people may require 100 mg. The total daily dosage should not exceed 400 mg. People who forget to take a dose of this drug should skip the dose and take the next one at the regularly scheduled time. They should not double up subsequent doses if one is missed. People should not take diphenhydramine if they are taking other preparations that contain antihistamines unless specifically directed to do so by a physician.

Precautions
People with peptic ulcer disease, bowel obstructions, an enlarged prostate, angle closure glaucoma, or difficulty urinating due to a blockage in the bladder should not use diphenhydramine without close physician supervision and monitoring. People with asthma, heart disease, high blood pressure, or an overactive thyroid should use this drug with caution. Before taking diphenhydramine, people with these conditions should discuss the risks and benefits of this drug with their doctor. Individuals should not take diphenhydramine for several days before an allergy test, as it will interfere with accurate results. Elderly people are more sensitive to the sedating effects of diphenhydramine. The drug may also cause dizziness and lower blood pressure. Older people should slowly change position from sitting or lying to standing while taking this medication to prevent dizziness and fainting.

Side effects
Drowsiness commonly occurs after taking diphenhydramine. This effect may be more pronounced if alcohol or any other central nervous system depressant, such as a tranquilizer or a particular medication for pain, is also taken. People taking the drug should not drive, or operate machinery, or perform hazardous tasks requiring mental alertness until the effects of the medication have worn off. In some people, diphenhydramine also may cause dizziness, difficulties with coordination, confusion, restlessness, nervousness, difficulty sleeping, blurry or double vision, ringing in the ears, headache, or convulsions. Stomach distress is a relatively common side effect of diphenhydramine. Some people may develop poor appetites, nausea, vomiting, diarrhea, or constipation. Individuals also may experience low blood pressure, palpitations, rapid or irregular heartbeats, frequent urination, or difficulty urinating. Urine may be retained in the bladder. Other side effects of diphenhydramine are associated with persons in age groups that are unlikely to use the drug.

Diphenhydramine may also cause hives, a rash, sensitivity to the sun, and a dry mouth and nose. Thickened lung secretions are common among older persons.

Interactions
Alcohol, pain medications, sleeping pills, tranquilizers, and antidepressants may make the drowsiness associated with diphenhydramine more severe. Diphenhydramine should not be used by persons taking hay fever medicines, sedatives, narcotics, anesthetics, barbiturates or muscle relaxants.

Read more: http://www.minddisorders.com/Del-Fi/Diphenhydramine.html#b#ixzz2bhcLUr6T

What is metronidazole?
Metronidazole is an antibiotic. It fights bacteria in your body. Metronidazole is used to treat bacterial infections of the vagina, stomach, skin, joints, and respiratory tract. This medication will not treat a vaginal yeast infection. Metronidazole may also be used for purposes not listed in this medication guide.

Important information about metronidazole

Take metronidazole for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Metronidazole will not treat a viral infection such as the common cold or flu. Do not drink alcohol while you are taking metronidazole and for at least 3 days after you stop taking it. You may have unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting.

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Why it's so important to manage your cholesterol levels.

Before taking metronidazole

You should not use this medication if you are allergic to metronidazole, or if you are in the first trimester of pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Before taking metronidazole, tell your doctor if you are allergic to any drugs, or if you have:

liver disease; a stomach or intestinal disease such as Crohn's disease; a blood cell disorder such as anemia (lack of red blood cells) or leukopenia (lack of white blood cells); epilepsy or other seizure disorder; or nerve disorders.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication. Metronidazole can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
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How should I take metronidazole?

Take metronidazole exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Take the extended-release metronidazole tablet (Flagyl ER) on an empty stomach, at least 1 hour before or 2 hours after eating a meal. Do not crush, chew, or break an extended-release tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time. Take metronidazole for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Metronidazole will not treat a viral infection such as the common cold or flu. To be sure metronidazole is not causing harmful effects, your blood may need to be tested often. Your liver function may also need to be tested. Visit your doctor regularly. This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using metronidazole. Store metronidazole at room temperature away from moisture and heat. See also: Metronidazole dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, vomiting, dizziness, loss of balance or coordination, numbness and tingling, or seizures (convulsions).

What should I avoid while taking metronidazole?

Do not drink alcohol while you are taking metronidazole and for at least 3 days after you stop taking it. You may have unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting. Check the labels of any medicines or food products you use to make sure they do not contain alcohol. Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking metronidazole and call your doctor. Do not use antidiarrhea medicine unless your doctor tells you to.
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Metronidazole side effects

Get emergency medical help if you have any of these signs of an allergic reaction to metronidazole: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

numbness or tingling in your hands or feet; white patches or sores inside your mouth or on your lips; pain or burning when you urinate; diarrhea that is watery or bloody; vision problems, pain behind your eyes; trouble concentrating, slurred speech, mood or behavior changes, tremors, muscle twitching, seizure (convulsions); fever, chills, muscle pain, confusion, headache, sore throat, neck stiffness, increased sensitivity to light, drowsiness, nausea and vomiting; or severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Less serious metronidazole side effects may include:

stomach pain, diarrhea; dizziness, loss of balance; vaginal itching or discharge; dry mouth or unpleasant metallic taste; cough, sneezing, runny or stuffy nose; or swollen or sore tongue.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. See also: Metronidazole side effects (in more detail)

What other drugs will affect metronidazole?

Tell your doctor about all other medicines you use, especially:

cimetidine (Tagamet); seizure medication such as phenytoin (Dilantin) or phenobarbital (Luminal, Solfoton); a blood thinner such as warfarin (Coumadin, Jantoven); lithium (Lithobid, Eskalith, others); or disulfiram (Antabuse).

This list is not complete and other drugs may interact with metronidazole. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor

What is sodium bicarbonate ()?

Sodium bicarbonate is an antacid that neutralizes stomach acid. Sodium bicarbonate is used to relieve heartburn and indigestion. Sodium bicarbonate is also used to make the blood and urine less acidic in certain conditions Sodium bicarbonate may also be used for purposes other than those listed in this medication guide.

What are the possible side effects of sodium bicarbonate ()?

Stop taking sodium bicarbonate and seek emergency medical attention if you experience a rare allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives). Stop taking sodium bicarbonate and notify your doctor if you experience nausea or vomiting; headache; sever mood changes; muscle pain; swelling of feet, ankles or legs decreased appetite; unusual tiredness; constipation; dry mouth or increased thirst; or increased urination. Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about sodium bicarbonate ()?
Do not take sodium bicarbonate or any antacids without first talking to your doctor if you take any other medications. Sodium bicarbonate contains a large amount of sodium. If you are on a sodium restricted diet or have high blood pressure talk to your health care professional before taking sodium bicarbonate.

What should I discuss with my healthcare provider before taking sodium bicarbonate ()?
Do not take sodium bicarbonate or any antacids without first talking to your doctor if you have: an intestinal problem or appendicitis;

heart problems; high blood pressure; swelling of the arms or legs; kidney disease; liver disease; or problems urinating; Talk to your doctor before taking sodium bicarbonate if you are pregnant. Talk to your doctor before taking sodium bicarbonate if you are breast-feeding.

How should I take sodium bicarbonate ()?

Take sodium bicarbonate exactly as directed by your doctor or follow the directions on the package. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you. Take the sodium bicarbonate tablets with a full glass of water. Store sodium bicarbonate at room temperature away from moisture and heat.

Sodium Bicarbonate Nursing Responsibilities

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Generic name: metronidazole Brand name: Flagyl Preparations: PO 7.5 mg/kg q6hr (not to exceed 4g/day) CLASSIFICATION: Anti-infectives, Anti-protozoals ACTION: Disrupts DNA and protein synthesis in susceptible organisms Bactericidal, or amebicidal action INDICATION / USES: Amebicide in the management of amebic dysentery

COMMON ADVERSE EFFECTS: CNS: seizures, dizziness, headache GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting Hematologic: leukopenia Skin: rashes, urticaria CONTRA-INDICATIONS: hypersensitivity NURSING CONSIDERATIONS: Administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty swallowing. Instruct patient to take medication exactly as directed evenly spaced times between dose, even if feeling better. Do not skip doses or double up on missed doses. If a dose is missed, take as soon as remembered if not almost time for next dose. May cause dizziness or light-headedness. Caution patient or other activities requiring alertness until response to medication is known. Inform patient that medication may cause an unpleasant metallic taste. Inform patient that medication may cause urine to turn dark. Advise patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black furry overgrowth on tongue; loose or foul-smelling stools develop).

Information on Sodium Bicarbonate Brand Name: Bakin Soda, Bell-Ans, Citrocarbonate, Neut, Soda Mint Classification: antiulcer agents, alkalinizing agent Indications 1. 2. Management of metabolic acidosis Used to alkalinize urine and promote excretion of certain drugs in over dosage situations

3. Used as an antacid Action Sodium Bicarbonate acts as an alkalinizing agent by releasing bicarbonate ions. Following oral administration of this medication, it releases bicarbonate which is capable of neutralizing gastric acid. Contraindication 1. 2. 3. 4. 5. 6. 7. Metabolic or respiratory alkalosis Hypocalcemia Excessive chloride loss It is not recommended as an antidote following ingestion of strong mineral acids Patients on sodium restricted diet Renal failure Severe abdominal pain of unknown cause especially if associated with fever

Used cautiously in patients with: 1. 2. Congenital heart failure Concurrent corticosteroid therapy

3. Children with diabetic ketoacidosis because taking sodium bicarbonate may increase the risk of cerebral edema 4. Chronis use as an antacid because it may result to metabolic alkalosis and possible sodium overload Side effects 1. 2. 3. 4. 5. 6. 7. 8. 9. Edema Flatulence Gastric distention Metabolic alkalosis Hypernatremia Hypocalcemia Hypokalemia Sodium and water retention Irritation at IV site

10. Tetany Nursing Responsibilities 1. 2. 3. 4. 5. 6. 7. 8. 9. Assess the clients fluid balance throughout the therapy. This assessment includes intake and output, daily weight, edema and lung sounds. Symptoms of fluid overload should be reported such as hypertension, edema, difficulty breathing or dyspnea, rales or crackles and frothy sputum. Sigs of acidosis should be assessed such as disorientation, headache, weakness, dyspnea and hyperventilation. Assess for alkalosis by monitoring the client for confusion, irritability, paresthesia, tetany and altered breathing pattern. Hypernatremia clinical manifestations should be assessed and monitored which includes: edema, weight gain, hypertension, tachycardia, fever, flushed skin and mental irritability. Hypokalemia should also be assessed by monitoring signs and symptoms such as: weakness, fatigue, U wave on ECG, arrhythmias, polyuria and polydipsia. IV sites should be observed closely. Extravasation should be avoided as tissue irritation or cellulitis may occur when taking sodium bicarbonate. If infiltration occurs, the physician should be notified immediately. Confer with the doctor or other health care staff regarding warm compresses and infiltration site with lidocaine or hyaluronidase. Monitor the clients serum calcium, sodium, potassium, bicarbonate concentrations, serum osmolarity, acid-base

balance and renal function before and throughout the therapy. 10. Tablets must be taken with a full glass of water. 11. For clients taking the medication as a treatment for peptic ulcers it may be administered 1 and 3 hours after meals and at bedtime

Calciumcarbonate BRANDNAMECalci-Aid DOSAGEAdult: 1-2capsulesdailyPedia:1-2 tabletsdaily Antacid,calciumsupplement,osteoporosis

Decreasestotal acid loadof GI tract.Increaseesophagealsphinctertone Hypercalcemia,bone tremors,severe renalfailure,hypersensitivityPRECAUTION:History of stoneformation,pregnancy ADVERSE RXNConstipation,flatulence,diarrhea, renaldysfunction,acid rebound> administeras antacid 1 hrfter meal andat bed time>administer assupplement 1 hrs aftermeal and atbed time>advice pt toincrease fluidsto 2L unlesscontraindicated