cefixime
suspension to treat otitis media because
Suprax
Class and Category
Chemical class: Third-generation cephalosporin,
7-aminocephalosporanic acid
Therapeutic class: Antibiotic
Pregnancy category: B
Indications and Dosages
To treat uncomplicated UTI caused by
Escherichia coli and Proteus mirabilis; otitis media
caused by Haemophilus
influenzae,Moraxella catarrhalis, or
Streptococcus pyogenes; pharyngitis
and tonsillitis caused by S. pyogenes;
acute bronchitis and acute exacerbations
of chronic bronchitis caused by H.
influenzae and Streptococcus pneumonia
Mechanism of Action
Interferes with bacterial cell wall synthesis
by inhibiting the final step in the crosslinking
of peptidoglycan strands. Peptidoglycan
makes cell membranes rigid and
protective.Without it, bacterial cells rupture
and die.
Contraindications
Hypersensitivity to cephalosporins or their
Components
Adverse Reactions
CNS: Chills, fever, headache, seizures
CV: Edema
EENT: Hearing loss
GI: Abdominal cramps, diarrhea, elevated
liver function test results, hepatic failure,
hepatitis, hepatomegaly, jaundice, nausea,
oral candidiasis, pseudomembranous colitis,
vomiting
GU: Elevated BUN level, nephrotoxicity,
renal failure, vaginal candidiasis
HEME: Eosinophilia, hemolytic anemia,
hypoprothrombinemia, neutropenia,
thrombocytopenia, unusual bleeding
MS: Arthralgia
RESP: Dyspnea
SKIN: Ecchymosis, erythema, erythema
multiforme, pruritus, rash, Stevens-Johnson
syndrome, toxic epidermal necrolysis
Other: Anaphylaxis, angioedema, facial
edema, superinfection
Nursing Considerations
• Use cefixime cautiously in patients with
impaired renal function or a history of GI
disease, especially colitis. Also use cautiously
in patients hypersensitive to penicillin
because cross-sensitivity has
occurred in about 10% of such patients.
• If possible, obtain culture and sensitivity
test results, as ordered, before giving drug.
• Tablets shouldn’t be substituted for oral
cefixime suspension produces a higher
peak blood level than do tablets when
administered at the same dose.
•Monitor BUN and serum creatinine for
early signs of nephrotoxicity. Also monitor
fluid intake and output; decreasing urine
output may indicate nephrotoxicity.
• Be aware that an allergic reaction may
occur a few days after therapy starts.
• Assess bowel pattern daily; severe diarrhea
may indicate pseudomembranous colitis.
• Assess for signs of superinfection, such as
perineal itching, fever, malaise, redness,
pain, swelling, drainage, rash, diarrhea,
and cough or sputum changes.
• Assess for pharyngitis, ecchymosis, bleeding,
and arthralgia; they may indicate a
blood dyscrasia.
PATIENT TEACHING
• Instruct patient to complete the prescribed
course of therapy.
• Advise patient to shake oral suspension
well before pouring dose and to use a calibrated
device to obtain an accurate dose.
• Instruct patient to store oral suspension at
room temperature and to discard unused
portion after 14 days.
• Tell patient to immediately report severe
diarrhea to prescriber.
• Inform patient that yogurt and buttermilk
can help maintain intestinal flora and
decrease diarrhea.
• Teach patient to recognize and report
signs of superinfection, such as furry
tongue, perineal itching, and loose, foulsmelling
stools.
azithromycin
Zithromax, Zmax
Class and Category
Chemical class: Azalide (subclass of
macrolide)
Therapeutic class: Antibiotic
Pregnancy category: B
Indications and Dosages
To treat mild community-acquired
pneumonia, otitis media, pharyngitis,
tonsillitis, and uncomplicated skin and
soft-tissue infections
To treat community-acquired pneumonia
caused by Chlamydophila pneumoniae,
Haemophilus influenzae,
Mycoplasma pneumoniae, or
Streptococcus pneumonia
Mechanism of Action
Binds to a ribosomal subunit of susceptible
bacteria, blocking peptide translocation and
inhibiting RNA-dependent protein synthesis.
Drug concentrates in phagocytes,
macrophages, and fibroblasts, which release
it slowly and may help move it to infection
sites.
Incompatibilities
Don’t add I.V. substances, additives, or
drugs to azithromycin I.V. solution, and
don’t infuse through the same I.V. line.
Contraindications
Hypersensitivity to azithromycin, erythromycin,
ketolide antibiotics, or other
macrolide antibiotics
Interactions
DRUGS
antacids that contain aluminum or magnesium:
Possibly decreased peak blood
azithromycin level, but extent of absorption
is unchanged
carbamazepine, cyclosporine, phenytoin, terfenadine
(drugs metabolized by P-450 cytochrome
system): Possibly increased blood
levels of these drugs
digoxin: Possibly increased blood digoxin
level
dihydroergotamine, ergotamine: Possibly
severe peripheral vasospasm and abnormal
sensations (acute ergot toxicity)
HMG-CoA reductase inhibitors: Increased
risk of severe myopathy or rhabdomyolysis
pimozide: Possibly sudden death
oral anticoagulants: Possibly potentiated
effects of oral anticiagulants
theophylline: Possibly increased blood theophylline
level
triazolam: Possibly decreased excretion and
increased therapeutic effects of triazolam
warfarin: Possibly increased anticoagulation
FOODS
food: Dramatically increased absorption
rate of azithromycin
Adverse Reactions
CNS: Aggressiveness, agitation, anxiety,
asthenia, dizziness, fatigue, headache, hyperactivity,
malaise, nervousness, paresthesia,
seizures, somnolence, syncope, vertigo
CV: Chest pain, edema, elevated serum CK
level, hypotension, palpitations, prolonged
QT interval, torsades de pointes, ventricular
tachycardia
EENT: Hearing loss, mucocutaneous candidiasis,
perversion or loss of taste or smell,
tinnitus
ENDO: Hyperglycemia
GI: Abdominal pain, anorexia, cholestatic
jaundice, constipation, diarrhea, dyspepsia,
elevated liver function test results, flatulence,
hepatic necrosis or failure, hepatitis,
nausea, pancreatitis, pseudomembranous
colitis, vomiting
GU: Acute renal failure, elevated BUN and
serum creatinine levels, nephritis, vaginal
candidiasis
HEME: Leukopenia, neutropenia, thrombocytopenia
MS: Arthralgia
SKIN: Erythema multiforme, photosensitivity,
pruritus, rash, Stevens-Johnson syndrome,
toxic epidermal necrolysis, urticaria
Other: Allergic reaction, anaphylaxis,
angioedema, elevated serum phosphorus
level, hyperkalemia, infusion site reaction
(such as pain and redness), new or worsening
myasthenia syndrome, superinfection
Nursing Considerations
•Obtain culture and sensitivity test results,
if possible, before starting therapy.
• Use azithromycin cautiously in patients
with hepatic dysfunction (drug is metabolized
in the liver) or renal dysfunction
(effects are unknown in this group).
• Give azithromycin capsules 1 hour before
or 2 to 3 hours after food. Give tablets or
suspension without regard to food.
liver function studies because drug is eliminated
mainly by the liver.
• Assess patient for bacterial or fungal
superinfection, which may occur with prolonged
or repeated therapy. If it occurs,expect to give another
antibiotic or antifungal.
•Monitor bowel elimination; if needed,
obtain stool culture to rule out pseudomembranous
colitis. If it occurs, expect to
stop azithromycin and give fluid, electrolytes,
and antibiotics effective with
Clostridium difficile.
PATIENT TEACHING
• Tell patient to take azithromycin capsules
1 hour before or 2 to 3 hours after food.
Instruct patient to take tablets or suspension
without regard to food.
• Tell patient to immediately report signs
and symptoms of allergic reaction (such as
rash, itching, hives, chest tightness, and
trouble breathing).
•Warn patient that abdominal pain and
loose, watery stools may occur. If diarrhea
persists or becomes severe, urge him to
contact prescriber and replace fluids.
• Because azithromycin may destroy normal
flora, teach patient to watch for and
immediately report signs of superinfection,
such as white patches in the mouth.
carvedilol
Coreg, Coreg CR
Class and Category
Chemical class: Nonselective beta-adrenergic
blocker with alpha1-adrenergic blocking
activity
Therapeutic class: Antihypertensive, heart
failure treatment adjunct
Pregnancy category: C
Indications and Dosages
To control hypertension
Mechanism of Action
Reduces cardiac output and tachycardia,
causes vasodilation, and decreases peripheral
vascular resistance, which reduces blood
pressure and cardiac workload.When given
for at least 4 weeks, carvedilol reduces plasma
renin activity.
Contraindications
Asthma or related bronchospastic conditions;
cardiogenic shock; decompensated
heart failure that requires I.V. inotropics;
history of serious hypersensitivity reactions,
such as anaphylaxis, angioedema, or
Stevens-Johnson syndrome; hypersensitivity
to carvedilol or its components; second- or
third-degree AV block, severe bradycardia
or hepatic impairment, or sick sinus syndrome
unless pacemaker is in place
Interactions
DRUGS
amiodarone; other CYP2C9 drugs, such as
fluconazole: Increased risk of bradycardia or
heart block
beta blockers, digoxin: Increased risk of
bradycardia
calcium channel blockers (especially diltiazem
and verapamil): Abnormal cardiac
conduction and, possibly, increased adverse
effects of calcium channel blockers
catecholamine-depleting drugs (such as reserpine,
MAO inhibitors): Additive effects,
increased risk of hypotension and bradycardia
cimetidine: Increased blood carvedilol level
clonidine: Risk of tachycardia and hypertension
when clonidine is discontinued
cyclosporine, digoxin: Increased blood levels
of these drugs
digoxin: Possibly increased digoxin level
oral antidiabetics: Increased risk of hypoglycemia
rifampin: Decreased blood carvedilol level
Adverse Reactions
CNS: Asthenia, depression, dizziness,
fatigue, fever, headache, hypesthesia, hypotonia,
insomnia, light-headedness, malaise,
paresthesia, somnolence, stroke, syncope,
vertigo
CV: Angina, AV block, bradycardia, edema,
heart failure, hypertension, hypertriglyceridemia,
orthostatic hypotension, palpitations,
peripheral vascular disorder
EENT: Blurred vision, dry eyes, periodontitis,
pharyngitis, rhinitis
ENDO: Hyperglycemia, hypoglycemia
GI: Abdominal pain, diarrhea, elevated liver
function test results, melena, nausea, vomiting
GU: Albuminuria, hematuria, elevated
BUN and creatinine levels, impotence, renal
insufficiency, UTI
HEME: Aplastic anemia, decreased PT,
thrombocytopenia, unusual bleeding or
bruising
MS: Arthralgia, arthritis, back pain, muscle
cramps
RESP: Dyspnea, increased cough
SKIN: Jaundice, pruritus, purpura, urticaria
Other: Anaphylaxis, angioedema, fluid
overload, gout, hyperkalemia, hyperuricemia,
hyponatremia, hypovolemia, viral
infection, weight gain or loss
Nursing Considerations
• Use carvedilol cautiously in patients with
peripheral vascular disease because it may
aggravate symptoms of arterial insufficiency.
In patients with diabetes mellitus it
may mask signs of hypoglycemia, such as
tachycardia, and may delay recovery.
•Monitor patient’s blood glucose level, as
ordered, during carvedilol therapy because
drug may alter blood glucose level.
• If patient has heart failure, expect to also
give digoxin, a diuretic, and an ACE
inhibitor.
PATIENT TACHING
• Instruct patient prescribed extendedrelease
capsules to swallow them whole. If
swallowing capsules is difficult, tell patient
he may open capsule and sprinkle beads
on a spoonful of cold applesauce and then
eat the applesauce immediately without
chewing.
•Warn patient that drug may cause orthostatic
hypotension, light-headedness, and
dizziness; advise him to take precautions.
• Tell patient with heart failure to notify
prescriber if he gains 5 lb or more in
2 days or if shortness of breath increases,
which may signal worsening heart failure.
• Alert patient with diabetes to monitor his
glycemic control closely because drug may
increase blood glucose level or mask
symptoms of hypoglycemia.
• Stress the need to seek emergency care if
patient develops hives or swelling of the
face, lips, tongue, or throat that causes
trouble swallowing or breathing.