AMOXICILLIN

potassium clavulanate, which

Classifications: anti-infective,

extend antibacterial spectrum of

antibiotic, aminopenicillin

amoxicillin to include beta-

ACTIONS Broad-spectrum,

acid

stable, semisynthetic
aminopenicillin and analogue of

lactamase producing strains.

CONTRAINDICATIONS
Hypersensitivity to penicillins;

ampicillin. Acts by inhibiting

infectious mononucleosis.

mucoprotein synthesis wall of

CAUTIOUS USE Hx of or

rapidly multiplying bacteria. It is

bactericidal and is inactivated by
penicilinase.
THERAPEUTIC EFFECTS

suspected atopy or allergy

(hives, eczema,hay fever,
asthma); severly impared renal

active

against both aerobic gram

function; Hx of cephalosporin
allergy; pregnancy (Category B)

negative bacteria including:

or lactation.

Enterococcus fecalis,

ADMINISTRATION

streptococcus pneumonia, e.coli,

haemophilus influenza,
helicobacter pylori
USES Infections of ear,nose,throat,
GU tract,skin, and soft tissue by

Oral
Ensure that chewable tablets are
chewed or crushed before being
swallowed with liquid.
Place reconstituted pediatric

susceptible bacteria. Also use in

drops directly on childs tounge or

uncomplicated gonorrhea.

add to formula, milk, fruit

Available in combination with

juice,water,ginger ale or other

soft drink. Have child drink all the

tissues and body fluids, except

prepared dose promptly.

synovial fluid and CSF( Unless

Store in tightly covered containers

at 15-30 degree celcius unless
otherwise directed.Reconstituted
oral suspensions are stable for
seven d at room temperature.
ADVERSE EFFECTS Body as a
Whole: As with other penicillins.
Hypersensitivity (rash,
anaphylaxis), superinfections. GI:
Diarrhea, nausea, vomiting,
pseudomembranous colitis (rare).
Skin: Pruritis, urticaria or other
skin eruptions. Special senses:
Conjuctival Ecchymosis
INTERACTIONS
TETRACYCLINES may inhibit
activity of amoxicillin.
PHARMOCOKINETICS
Absorption: Rapid and nearly
complete absorption. Peak: 1-2
h. Distribution: Diffuses into most

meninges are inflamed); crosses

placenta; distributed into
breastmilk in small amounts.
Metabolism: Metabolized in the
liver.
Elimination: 60% of dose is
excreted in the urine in 6-8h.
Half-life: 1-1.3 h
Patient & Family Education
Take drug around the

clock, do not miss a dose,

and contine theraphy until
all medication is taken,
unless otherwise directed
by physician.

Report onset of diarrhea

and other symptoms of
such as superinfection to
physician.

Do not breastfeed while

taking this drug without
consulting phycisian.

2g/dL and Hct by 6% in 3 wk.

FERROUS SULFATE
Classifications: BLOOD FORMERS,
COAGULATORS AND ANTICOAGULANTS; IRON
PREPARATION

Standard iron preparation against

which other oral iron preparations
are usually measured. Correct
erythropoietic abnormalities
induced by iron deficiency but
does not stimulate erythropoiesis.
May reverse gastric , esophageal,
and other tissue changes caused
by lack of iron.
THERAPEUTIC EFFECTS:
Experience within 48h as a sense
of well-being, increased vigor,
improved appetite, and decreased
irritability(in children).
Reticulolcyte response begins in
about 4d;
It usually peaks in 7-10d
(reticulocytosis)
And returns to normal after 2-3
wk.Hgb generally increases by

Iron supplements correct

erythropoietic abnormalities
induced by iron deficiency but do
not stimulate erythropoiesis.
USES To correct simple iron
deficiency and to treat iron
deficiency
(microcytic,hypochromic)anemias.
Also may be used prophylactically
during periods of increased iron
needs,as
in infancy, childhood, and
pregnancy.
CONTRAINDICATIONS Peptic
ulcer, regional enteritis, ulcerative
colitis; hemolytic anemias (in
absence of iron deficiency)
hemochromatosis, hemosiderosis,
patients receiving repeated
transfusions, pyridoxine
responsive anemia;cirrhosis of the

liver.

the back of tongue with a dropper

to prevent teeth staining and to

CATIOUS USE

Pregnancy

ADMINISTRATION
Oral
Give on an empty stomach if
possible because oral iron
preparations are best absorbed
then(i.e. between meals). Minimize
gastric distress if needed by giving

mask taste. Instruct the patient to

rinse mouth with clean water
immediately after ingestion.
Mix ferosol elixir with water;not
compatible with milk or friuit juice.
Fer-In-Sol (drops) may be given in
water or in fruit or in vegetable
juice, according to manufacturer.

with or immediately after meals

Do not use discolored tablets.

with adequate liquid.

Store in tightly closed containers

Do not to crush tablet or empty

contents of capsule when

and protect from moisture. Store at

15-30 degree celcius.

administering
Do not give tablets or capsules
within 1h of bedtime.
Consult phycisian about prescribing
a liquid formulation or less

ADVERSE EFFECTS
GI: nausea, heartburn, anorexia
,constipation, diarrhea, epigastric
Pain, abdominal distress, black

corrosive form, such as ferrous

stools. Special senses: Yellow-

gluconate, if the patient

brown discoloration of eyes and

experiences difficulty of swallowing

teeth(liquid forms.) Large Chronic

tablet or capsule.

Doses in infants. Rickets( d/t

Dilute liquid preparation well and

give through a straw or placed on

interference with phosphorus

absorption.) Massive overdosage

Lethargy, drowsiness, n/v,

decrease

abdominal pain,diarrhea, local

absorption of penicilllamine.

corrosion of the stomach and small

Food: Food decreases absorption

intestines,pallor or

of iron ; ascorbic acid( vitamin

cyanosis,metabolic acidosis,shock

C)may increasen iron absorption.

Cardiovascular
collapse,convulsions,
Liver necrosis, coma, renal failure
and death.

5-10% absorbed in healthy

individuals; 10-30% absorbed in

DIAGNOSTIC TEST INTERFERNCE

By coloring feces black, large iron
doses may cause false positive
tests

For occult blood with orthotoluidine

(Hematest, Occultist,Labstix);
guaiac regain benzidine test is
reportedly not affected.
INTERACTIONS DRUG:

iron deficiency; food decreases

amount absorbed. Distribution:
Transported by transferriin to bone
marrow, where it is incorporated
into hemoglobin; crosses placenta.
Elimination: Most of iron released
from hemoglobin is reused in the
body ; small amounts are lost in
desquamation of skin, GI mucosa,

ANTACIDS

decreases iron absorption; iron

decreases absorption of
TETRACYCLINES,

PHARMACOKINETICS Absorption:

Ciprofloxacin,

ofloxacin, chloramphenicol may

delay iron effects;Iron may

nails, and hair; 12-30 mg/ mo lost

trough menstruation.

NURSING IMPLICATIONS

lambia. Exhibits antibacterial

Assessment & Drug Effects

activity against obligate anaerobi

Lab tests: Monitor Hgb and

reticulocyte values during

theraphy. Investigate the absence

of satisfactory response after 3 wk
of drug treatment.
Continue iron theraphy for 2-3 mo
after the hemoglobin level has
returned to normal

Monitor bowel movements as

constipation is common adverse
effect.
METRONIDAZOLE
CLASSIFICATIONS: ANTIINFECTIVE,
ANTITRICHOMONAL, AMEBICIDE, ANTIBIOTIC

ACTIONS Synthetic compounds

with direct trichomonicidal
amebicidal activity as well as
antibacterial against anaerobic
bacteria and some gram-negative
bacteria.
THERAPEUTIC EFFECTS effective
against trichomonas vaginalis,
entamoeba histolytica and gardia

bacilli, and clostridia.

Microaerophilic streptococci and
most aerobic bacteria are present.
USES Asymptomatic and
symptomatic trichomoniasis in
females and males; acute
intestinal amaebiasis & amebic
liver abcess; preoperative
prophylaxis in colorectal surgery,
elective hysterectomy or vaginal
repair and emergency
appendectomy. IV metronodazole
is used for the treatment of
serious infections cause by
susceptible anaerobic bacteria in
intraabdominal infections, skin
infections,and for both pre and
post operative prophylaxis,
bacterial vaginosis. Topical:
Rosacea

UNLABELED USES: Treatment of

distributed to most body

membranous colitis, Chrons

tissues , including CSF, bone,

disease, H. pylori eradicaton

cerebral And hepatic abscesses,

ADMINSTRATION
Oral
Crush tablets before ingestion if
the patient cannot swallow
whole.

Ensure that Flagyl ER is not

chewed or crushed.

It must be swallowed whole.

Give on an empty stomach , 1h
before or 2h after meals.
Give immediately before ,with,or
immediately after meals or with
food or milk to reduce GI
distress
Give lower than normal doses in
presence of liver disease
PHARMACOKINNETICS
Absorption: 80% of dose is
absorbed from GI tract. Peak: 13h. Distribution: widely

crosses placenta

;distributed in breastmilk.
Metabolism: 77% excreted in
the urine ,14% in feces w/in
24h.
Half-life: 6-8h
NURSING IMPLICATIONS
Assessment & Drug Effects
Discontinue theraphy
immediately if symptoms of
CNS toxicity develop. Monitor
esp. for seizure and peripheral
neuropathy and paresthesia of
extremeties
Lab tests: Obtain total and
differencial WBC count before,
during and after theraphy, esp
if second course is necessary
Monitor for S&S for sodium
retention, esp. in pateients of
corticosteroid theraphy or with
the history of CHF

 Monitor patients on lithium for

elevated lithium levels

Report appearance on
candidiasis or its becoming
more prominent with therapy to
physician promptly

Repeat feces examination

usually up to 3 months to
ensure that amoeba have been
eliminated.