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Cefepime, considered to be a fourthgeneration cephalosporin antibiotic, is similar to third-generation cephalosporins with respect to broad gram-negative coverage; however, cefepime has broader gram-positive coverage than thirdgeneration cephalosporins. It is highly resistant to hydrolysis by most beta-lactamase bacteria. Cefepime preferentially binds to one or more of the penicillin-binding proteins (PBPs) located on cell walls of susceptible organisms. This inhibits the third and final stage of bacterial cell wall synthesis, thus killing the bacteria (bactericidal).

DOSAGE AND ROUTE Mild to Moderate Infections Adult: IV/IM 0.51g q12h times 710 d


CONTRAINDICATI ON Hypersensitivity to cefepime, other cephalosporins, penicillins, or other beta-lactam antibiotics.

ADVERSE EFFECTS Body as a Whole: Eosinoph ilia. GI: Antibioticassociated colitis, diarrhea, nausea, oral moniliasis, vomiting, elevated liver function tests (ALT, AST). CNS: Headache, fever. Skin: Phlebitis, pain, inflammation, rash, pruritus, urticaria. Urogenital: Vagin itis.


Generic Name: Cefepime Brand Name: Maxipime Class: Anti-infective Antibiotic 4th Gen. Cephalosporins

Uncomplicated and complicated UTI, skin and skin structure infections, pneumonia caused by Moderate to susceptible Severe organisms Infections (Escherichia coli, Adult: IV 1 Klebsiella 2g q12h pneumoniae, times 10 d Proteus mirabilis, Staphylococcus Febrile aureus [methicillin Neutropenia Adult: IV 2 g sensitive], Strepto q8h for 7 d or coccus pyogenes, until Streptococcus resolution of pneumoniae, neutropenia Pseudomonas aeruginosa, Adjustment Enterobacter sp). for Renal Empiric Impairment monotherapy for Clcr 3060 febrile mL/min: neutropenic dose q24h; patients. 1129 mL/min: give 50% of normal dose

-Determine history of
hypersensitivity reactions to cephalosporins, penicillins, or other drugs before therapy is initiated. -Lab tests: Perform culture and sensitivity tests before initiation of therapy. Dosage may be started pending test results. -Monitor for S&S of hypersensitivity Report their appearance promptly and discontinue drug. Monitor for S&S of superinfection or pseudomembranous colitis immediately report either to physician. With concurrent highdose aminoglycoside therapy, closely monitor for nephrotoxicity and ototoxicity.

q24h; <10 mL/min: 250500 mg q24h

DRUG ORDER Generic Name: Insulin glulisine Brand Name: Apidra Classification: insulin dependent



CONTRAINDICATION Contraindicated with allergy to insulin glulisine and during episodes of hypoglycemia.

ADVERSE EFFECT Hypoglycemia, hypokalemia, local or systemic allergy, lipodystrophy, weight gain, peripheral edema.

NURSING RESPONSIBILITY Instruct patients on diet, exercise, blood or urine testing, proper administration of insulin, and management of hypoglycemia. Monitor glucose, potassium levels (esp. by IV route). Mixing: APIDRA for subcutaneous injection should not be mixed with insulins other than NPH insulin. Do not mix APIDRA with any insulin for intravenous administration or for use in a continuous infusion pump

Regulation of glucose type 2 diabetes metabolism is the primary activity of insulins and insulin analogs, including insulin glulisine. Insulins lower blood glucose by stimulating peripheral glucose uptake by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulins inhibit lipolysis and proteolysis, and enhance protein synthesis.

DRUG Generic name: Cefuroxime sodium Brand name: Zinacef Classification: 2nd generation cephalosporin Antibiotic

MODE OF ACTION Bactericidal: Inhibits synthesis of bacteria cell wall, causing cell death.

DOSAGE INDICATION AND ROUTE IV - 375 mg - For lower Q8 respiratory tract infections caused by S. pneumoniae, S. aureus, E. coli, Klebsiella pneumoniae, H. influenzae

CONTRAINDICATIO N Allergy to cephalosporins and penicillins Use cautiously with renal failure

ADVERSE EFFECTS CNS: headache, dizziness, lethargy, paresthesia GI: nausea and vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, hepetotoxocity GU: nephrotoxocity Hematology: WBC, platelets, Hct Hypersensitivity Local pain

NURSING RESPONSIBILITIES Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. (-ANST) Check IV site for signs of phlebitis. Make sure of medication compliance. Report onset of loose stools or diarrhea. Although pseudomembranous colitis rarely occurs, this potentially lifethreatening complication should be ruled out as the cause of diarrhea during and after antibiotic therapy. Monitor for manifestations of hypersensitivity Discontinue drug and report their appearance promptly. Monitor I&O rates and pattern:

Especially important in severely ill patients receiving high doses. Report any significant changes.


MODE OF ACTION Generic name: Stimulates betaAlbuterol 2 receptors of bronchioles by Brand name: increasing levels Salbutamol of cAMP which relaxes smooth Classification: muscles to Bronchodilator produce bronchodilation. Also cause CNS stimulation, cardiac stimulation, increased diuresis, skeletal muscle tremors, and increased gastric acid secretion. Longer acting than isoproterenol.

DOSAGE AND ROUTE Inhalation Dilute 5 mg/mL solution/2.5 mL 0.9% NaCl for inhalation.

INDICATION Relief of bronchospasm in bronchial asthma, chronic bronchitis. Also useful for treating bronchospasm in patients with coexisting heart disease of hypertension.

CONTRAINDICATIO N Contraindicated with hypersensitivity to albuterol; tachyarrhythmias, tachycardia cause by digitalis intoxication. Use cautiously with diabetes mellitus; hyperthyroidism, his tory of seizure disorders

ADVERSE EFFECTS CNS: Restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesia, insomnia, tremor, drowsiness, irritability, weakness, vertigo, headache CV: Cardiac arrhythmias, tachycardia, palpitations, PVCs (rare), anginal pain Dermatologic: Sweating, pallor, flushing GI: Nausea, vomiting, heartburn, unusual or bad taste in mouth GU: Increased incidence of leiomyomas of uterus when given in higher than human doses in preclinical studies Respiratory: Respiratory difficulties, pulmonary edema, coughing, bronchospasm, paradoxical airway resistance with repeated,

NURSING RESPONSIBILITIES Assess lung sounds, PR and BP before drug administration and during peak of medication. Prepare solution for inhalation by diluting 0.5 mL 0.5% solution with 2.5 mL normal saline; deliver over 515 min by nebulization. Do not exceed recommended dosage. Observe for paradoxical spasm and withhold medication and notify physician if condition occurs. Use minimal doses for minimal periods; drug tolerance can occur with prolonged use. Maintain a beta-adrenergic blocker (cardioselective betablocker, such as atenolol, should be used with respiratory distress) on standby in case cardiac arrhythmias occur.

excessive use of inhalation preparations

Peform chest physiotherapy after nebulization.







Generic Name: Paracetamol Functional class: Antipyretics Chemical class: Non-opioid analgesics

300 mg IV q 6 PRN

Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS.

Indication: Fever.

GI: HEPATIC FAILURE, HEPATOTOXICITY (OVERDOSE). GU: renal failure (high doses/chronic use).

Contraindication: Previous hypersensitivity Use Cautiously in: Malnutrition.

Assess overall health status before administering acetaminophen. Patients who are malnourished is at higher risk of developing hepatotoxicity with chronic use of usual doses of this drug. Assess fever, note presence of associated signs (diaphoresis, tachycardia, and malaise).

Hema: neutropenia, pancytopenia, leukopenia. Derma: rash, urticaria. Monitor temperature to assess if there is decrease in temperature.

MECHANISM OF ACTION Generic Block calcium Name: entrance into Diltiazem cardiac and vascular smooth Brand Name: muscle cells by blocking the L-type Dilzem voltage senstive calcium channel Classification: which is abundant Calcium in cardiac and antagonist smooth muscle, thus by decreasing calcium levels in the vascular smooth muscle these agents lessen contraction.


INDICATIONS Angina pectoris, hypertension

CONTRAINDICATION Contraindicated with allergy to dilzem and severe hypotension

ADVERSE EFFECT dizziness, lightheadedness,headache,ast henia,fatigueperipheraledema,hypoten sion,arrhythmias,bradycar dia, AVblock, asystoleflushing,rash-nausea, hepaticinjury, reflux

NURSING RESPONSIBILITY Monitor BP carefully if patient is on concurrent doses of nitrates. Ensure thet the patient swallows whole preparations; do not cut,crush, or chew Should be administered w/food or after eating to prevent GI upset.