Camilo, Dexter M.

RESPIRATORY DRUGS
BSN III-2

GENERIC NAME ASTHMA

BRAND NAME DRUGS
INDICATION DOSAGE SIDE EFFECTS ADVERSE EFFECTS CONTRAINDICATIONS NURSING
CONSIDERATIONS
BUDESONIDE SYMBICORT As a Adult:  headache,  Nasopharyngitis  Primary  Taper systemic
preventative in Allow approx.12hrs  throat irritation,  pharyngeal pain, treatment of status steroids carefully
maintenance of between doses. Asthma:  nausea,  sinusitis, asthmaticus or during transfer to
asthma. Base initial dose on  vomiting,  nasal congestion acute attacks of inhalational
asthma severity. 2 inh of  stomach upset,  oral candidiasis, asthma or COPD steroids; deaths
80/4.5 or 160/4.5 twice  diarrhea,  upper respiratory requiring intensive from adrenal
daily (AM & PM). If  back pain, infection measures. insufficiency have
insufficient response  stuffy nose,  flu occurred.
after 1–2 weeks using  muscle or joint  back pain,  Arrange for use
80/4.5 strength, may pain, or  stomach of decongestant
switch to 160/4.5  changes in your discomfort, nose drops to
strength. Max 2 inh of voice.  vomiting facilitate
160/4.5 twice daily.  hypersensitivity penetration if
Titrate to lowest reactions. edema, excessive
effective strength after secretions are
adequate response. present.
COPD: 2 inh of 160/4.5  Prime unit
twice daily. Rinse mouth before use
after use. for Pulmicort
Children: Turbuhaler; have
Allow approx. 12hrs patient rinse mouth
between doses. Asthma: after each use.
<6yrs: not established.  Use aerosol
6–<12yrs: 2 inh of 80/4.5 within 6 mo of
twice daily (AM & PM). opening. Shake well
Rinse mouth after use. before each use.
COPD: not indicated.  Store Respules 
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

upright and
protected from
light; gently shake
before use; open
envelopes should be
discarded after 2
wk.

SALMETEROL SEREVENT Long term Asthma Prevention and  Cough producing  anxiety  Hypersensitivit  instruct patient
DISKUS maintenance of Maintenance mucus  tremor y is a to avoid excessive
asthma; to Administer as additional  difficulty with  nervousness contraindication use
prevent therapy for patients  breathing  sleep disturbance for salmeterol. It is  can cause
bronchospasm currently taking but  headache  fever contraindicated in headache
in patients with inadequately controlled  irritation of the  paresthesia patients with a palpitations
nocturnal on an inhaled throat known tachycardia,
asthma. corticosteroid (ICS); not  runny nose hypersensitivity to abdominal pain,
for patients whose  sneezing any ingredient in paradoxical
asthma is adequately  stuffy nose the preparation, bronchospasm
controlled on low-or  tightness in the including lactose  beta blockers
medium-dose ICS chest and milk protein. and decrease
1 inhalation (50 mcg) effectiveness
twice daily; not to  assess
exceed twice daily respiratory status
administration  may increase
Prevention of Exercise- glucose levels
Induced Asthma  always take
Use as a single agent for bronchodialtor first.
the prevention of EIB
may be clinically
indicated in patients who
do not have persistent
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

asthma
1 inhalation 30 minutes
before exercise; a
second dose not to be
administered for another
12 hr; not for use in
individuals receiving
twice-daily therapy of
salmeterol

IPRATTOPIUM ATROVENT Acute asthma Adults and adolescents  dry mouth,  Palpitations  Contraindicated in  If patient uses face
HFA exacerbations, age 13 and older.  cough,  Chest pain patient with a mask for a
in combination 500 mcg via oral  headache,  HTN history of nebulizer, take care
with short nebulizer every 20  nausea,  Blurred vision hypersensitivity to to prevent leakage
acting beta minutes for three doses,  dizziness, and soya lecithin or around the mask
agonist. then as needed: or 8  difficulty breathing related food such because eye pain or
inhalation aerosol every . as soybean and temporary blurring
20 minutes as needed peanut. of vision may occur.
for up to 3 hours.  Aerosol should also  Safety and
Children ages 6 to 12: not be taken by effectiveness of
250 to 500 mcg via oral patients intranasal use
nebulizer every 20 hypersensitive to beyond 4 days in
minutes for three doses, any other patients with a
then as needed; or 4 to 8 components of the common cold
inhalations aerosol every drug product or to haven’t been
20 minutes as needed atropine or it’s established.
for up to 3 hours. derivatives.
Children age 5 and
younger:
250 mcg via oral
nebulizer every 20
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

minutes for I hour: or 2

inhalations of inhalation
of aerosol every 20
minutes if needed for 1
hour.
ALBATEROL ACCUNEB To prevent or Intravenous infusion  headache,  Tremor  Contraindicated in  may decrease the
treat solution:  dizziness,  Nervousness patients effectiveness of
bronchospasm -Dilute 5 mL of this drug  sleep problems  Headache hypertensive to Beta Blockers
in patients with (1000 mcg/mL) in 500 (insomnia),  Hyperactivity drug or it’s  use caution with
reversible mL of Sodium Chloride  cough,  Insomia ingredients. o heart disease
obstructive Injection, or Sodium  hoarseness,  Dizziness o diabetes
airway disease. Chloride and Dextrose.  sore throat,  weakness o glaucoma
-Infusion rates can be  runny or stuffy  malaise o seizure disorder
started at 5 mcg/min, nose,  overuse of inhalers
and can be increased to  nausea, can lead to
10 mcg/min and 20  vomiting, bronchospasm
mcg/min at 15 at 30  dry mouth and  monitor for chest
minute intervals, if throat, pain and
necessary.  muscle pain, or palpitations
 diarrhea.  can decrease
Nebulizer inhalation digoxin levels
solution:
-2.5 mg three or four
times a day by
nebulization, over
approximately 5 to 15
minutes.
MONTELUKAST SINGULAIR Asthma, For adults and  skin rash,  Headache  Contraindicated in  Monitor
seasonal allergic adolescents 15 years of  mood changes,  Asthenia patients effectiveness
rhinitis, age and older: one 10-  tremors,  Dizziness hypertensive to carefully when used
perennial mg tablet.  headache,  Fatigue drug or it’s in combination with
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

rhinitis For pediatric patients 6  stomach pain,  Fever ingredients. phenobarbital or

to 14 years of age: one  heartburn,  Somnolence  Contraindicated in other potent
5-mg chewable tablet.  upset stomach,  Weakness patients with cytochrome P450
For pediatric patients 2  nausea, previous sensitivity enzyme inducers.
to 5 years of age: one 4-  diarrhea, to montelukast.  Lab test:
mg chewable tablet or  tooth pain,  Not used to treat Periodic liver
one packet of 4-mg oral  tiredness, acute asthma function tests.
granules.  fever, attack and cannot  Do not use for
For pediatric patients 12  stuffy nose, substitute inhaled reversal of an acute
to 23 months of age: one  sore throat, or oral asthmatic attack.
packet of 4-mg oral  cough, corticosteroids.  Inform
granules.  and hoarseness.  Monitor for physician if short-
Safety and effectiveness eosinophilia, acting inhaled
in pediatric patients less vasculitic rash, bronchodilators are
than 12 months of age worsening of needed more often
with asthma have not pulmonary than usual with
been established. symptoms, cardiac montelukast.
Patients who miss a dose complications and  Use chewable
should take the next neuropathy. tablets (contain
dose at their regular phenylalanine) with
time and should not take caution with PKU.
2 doses at the same  Do not breast
time. feed while taking
this drug.
FLUTICASONE FLOVENT As preventive in Adult And Adolescent  upper respiratory  headeache  Patient with  You can take this
maintenance of Patients Aged 12 Years tract infection  dizziness hypertension, drug with or without
chronic asthma And Older  throat, nose,  fever immediate food.
in patients The recommended and/or sinus  migraine hypersensitivity  Take your doses 12
requiring oral starting dosage for irritation  nervousness reactions, including hours apart.
corticosteroid. patients aged 12 years  nausea and anaphylaxis, can  Monitor
and older who are not vomiting occur patient, especially
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

on an  cough and/or  Contraindicated as postoperatively,

inhaled corticosteroid is persistent primary treatment during periods of
100 mcg twice daily, cough of patients with stress or severe
approximately 12 hours  fever status asthmaticus attack of asthma for
apart. For other patients,  headache or other acute , inadequate adrenal
and for patients who do  upset stomach intense episodes of response
not respond adequately asthma.  Advise patient
to the starting dosage to report all adverse
after 2 weeks of therapy, reactioc ns.
higher dosages may
provide additional
asthma control. The
maximum recommended
dosage for patients aged
12 years and older is
1,000 mcg twice daily.
Pediatric Patients Aged
4 To 11 Years
For patients aged 4 to 11
years not on an inhaled
corticosteroid, the
recommended starting
dosage is 50 mcg twice
daily, approximately 12
hours apart. For other
patients, and for patients
who do not respond
adequately to the
starting dosage after 2
weeks of therapy,
increasing the dosage to
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

100 mcg twice daily may

provide additional
asthma control. The
maximum recommended
dosage for patients aged
4 to 11 years is 100 mcg
twice daily.

TUBERCULOSIS DRUGS
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

GENERIC NAME BRAND NAME INDICATIONS DOSAGE SIDE EFFECTS ADVERSE EFFECTS CONTRAINDICATIONS NURSING
CONSIDERATIONS
RIFAMPIN RIFADIN Asymptomatic Adult:  upset  ataxia, Contraindicated in  Lab tests: Periodic liver
carriers Give 1hr before or 2hrs stomach,  inability to patient with: function tests are
of Neisseria after meals with water.  heartburn, concentrate,  Hypersensitivity to advised. Closely
meningitidis to 600mg twice daily for 2  nausea,  mental rifampin; monitor patients with
eliminate days.  menstrual confusion,  obstructive biliary hepatic disease.
meningococci from Children: changes,  muscular disease;  Check prothrombin
nasopharynx. Not Give 1hr before or 2hrs  headache, weakness,  meningococcal time daily or as
for treatment of after meals with water.  drowsiness,  pain in disease; necessary to establish
meningococcal <1 month: 5mg/kg  tired feeling, extremities  intermittent and maintain required
infection. every 12hrs for 2 days. or  generalized rifampin therapy; anticoagulant activity
≥1 month: 10mg/kg  dizziness. numbness,  lactation when patient is also
every 12hrs for 2 days;  urticaria receiving an
max 600mg per dose.  edema anticoagulant.
Preparation of  hepatotoxicit  Do not interrupt
suspension: see full y, prescribed dosage
labeling.  hepatitis, regimen. Hepatorenal
 abnormal reaction with flu-like
LFTs, cholestasis syndrome has occurred
when therapy has been
resumed following
interruption.
 Be aware that drug
may impart a harmless
red-orange color to
urine, feces, sputum,
sweat, and tears. Soft
contact lenses may be
permanently stained.
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

 Report onset of
jaundice,
hypersensitivity
reactions, and
persistence of GI
adverse effects to
physician.

RIFABUTIN MYCOBUTIN For the prevention Adult:  Black, tarry  Discolored Contrainidcated in  Monitor patients for
of ≥18yrs: 300mg once stools urine, patient with: S&S of active TB.
disseminated Myc daily. If inclined to GI  chest pain  GI upset,  diarrhea from an Report immediately.
obacterium upset, may give 150mg  chills  abdominal infection with  Lab tests: Monitor
avium complex twice daily with food.  cough pain, Clostridium difficile periodic blood work for
(MAC) disease in Severe renal  diarrhea  dyspepsia, bacteria neutropenia and
patients with impairment (CrCl  fever  myalgia,  decreased blood thrombocytopenia.
advanced HIV <30mL/min),  heartburn  taste platelets  Evaluate patients on
infection. concomitant  indigestion perversion  low levels of a type concurrent oral
amprenavir, indinavir,  itching or skin  neutropenia, of white blood cell hypoglycemic therapy
or nelfinavir: reduce rash  thrombocyto called neutrophils for loss of glycemic
rifabutin dose by 50%.  loss of penia,  severe renal control.
Concomitant ritonavir, appetite  leukopenia impairment  Review patient's
fosamprenavir/ritonavi  painful or  myositis, complete drug regimen
r, lopinavir/ritonavir, difficult urination  uveitis. because dosage
saquinavir/ritonavir,  sore throat adjustment of a
tipranavir/ritonavir:  ulcers, sores, significant number of
reduce rifabutin dose or white spots in drugs may be needed
by 75% (to max 150mg the mouth when rifabutin is added
every other day or 3  unusual to regimen.
times per week). bleeding or
Children: bruising
<18yrs: not  unusual
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

established. tiredness or
weakness

RIFAPENTINE PRIFTIN Susceptible active Adults and Children:  stomach  Lymphopenia  contraindicated in  Lab tests: Sputum
pulmonary Take with food. If upset, nausea, , patients with a smear and culture,
tuberculosis. unable to swallow tabs:   vomiting,   neutropenia, history of CBC, baseline liver
Latent tuberculosis may crush and add to  loss of  anemia, hypersensitivity to functions (especially
infection in semi-solid food. Active appetite,  increased rifamycins. serum transaminases)
patients ≥2yrs old TB: <12yrs: not  stomach pain, ALT, to rule out preexisting
at high risk of established. ≥12yrs:  diarrhea,  arthralgia, hepatic disease and
progression to Initial phase: 600mg   joint pain,   conjunctivitis serum creatinine and
tuberculosis twice weekly for 2  skin rash or , BUN.
disease. months, with an  itching, or  pruritus,  Monitor carefully for
interval of no less than  red, orange, or  anorexia, S&S of toxicity with
3 consecutive days brown  lymphadeno concurrent use of oral
(72hrs) between doses, discoloration of pathy,  anticoagulants, digitalis
in combination with your skin, preparations, or
other antituberculosis tears, sweat, saliv anticonvulsants.
drugs (eg, isoniazid, a, urine, or  Follow strict adherence
ethambutol, stools. to the prescribed
pyrazinamide); dosing schedule to
Continuation phase: prevent emergence of
Following Initial phase, resistant strains of
600mg once weekly for tuberculosis.
4 months in  Be aware that food
combination with may be useful in
isoniazid or an preventing GI upset.
appropriate  Report immediately
antituberculosis agent. any of the following to
Latent TB: <2yrs: not the physician: fever,
established. Give once weakness, nausea or
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

weekly in combination vomiting, loss of

with isoniazid (see full appetite, dark urine or
labeling for dosage) for yellowing of eyes or
12 weeks. ≥2yrs: (10– skin, pain or swelling of
14kg): 300mg; (14.1– the joints, severe or
25kg): 450mg; (25.1– persistent diarrhea.
32kg): 600mg; (32.1–  Use or add barrier
50kg): 750mg; (>50kg): contraceptive if using
900mg. Max 900mg hormonal
once weekly. contraception.
 Do not breast feed
while taking this drug.

PYRAZINAMIDE RIFATER Pyrazinamide is Adults and Children:  nausea,  Hepatitis, Contraindicated in  Observe and supervise
indicated for the 15–30mg/kg once daily;  upset stomach,  liver patient with: closely. Patients should
initial treatment of max 2g daily. Or 50–  vomiting, dysfunction,  diabetes receive at least one
active tubercuIosis 70mg/kg twice weekly  loss of appetite,  gout,  a type of joint other effective
in adults and based on lean body  mild muscle  GI disorder due to antituberculosis agent
children when weight. or joint pain, or disturbances, excess uric acid in concurrently.
combined with  fatigue.  arthralgia, the blood called gout  Examine patients at
other antitubercu-  myalgia,  porphyria regular intervals and
lous agents.  blood  alcoholism question about
dyscrasias (rare).  severe liver disease possible signs of
toxicity: Liver
enlargement or
tenderness, jaundice,
fever, anorexia,
malaise, impaired
vascular integrity
(ecchymoses,
petechiae, abnormal
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

bleeding).
 Hepatic reactions
appear to occur more
frequently in patients
receiving high doses.
 Lab tests: Obtain liver
function tests
(especially AST, ALT,
serum bilirubin) prior
to and at 2–4 wk
intervals during
therapy. Blood uric
acid determinations
are advised before,
during, and following
therapy.

ISONAIZID ISOTAMINE Treatment of Adult:  numbness and  Peripheral Contraindicated in  Monitor for
latent TB infection Prophylaxis: 300mg tingling in the  neuropathy patient with: therapeutic
greatly reduces the once daily. Active extremities, (esp. in slow  Drug-induced effectiveness: Evident
risk that TB infection: 5mg/kg daily;  hepatitis (sympto acetylators) hepatitis. within the first 2–3 wk
infection will max 300mg once daily. ms include loss of  elevated  Previous isoniazid- of therapy. Over 90%
progress to acitve Do not interrupt appetite, serum associated hepatic of patients receiving
disease therapy. nausea, vomiting, transaminases injury. optimal therapy have
Children: fatigue, malaise, (SGOT; SGPT),  Severe adverse negative sputum by the
Prophylaxis: 10mg/kg and weakness),  bilirubinemia reactions to sixth month.
once daily; max 300mg  nausea, , isoniazid (eg, drug  Perform appropriate
daily. Active infection:  vomiting,  bilirubinuria, fever, chills, susceptibility tests
10–20mg/kg once daily;  upset stomach,  jaundice, arthritis). before initiation of
max 500mg daily. Do  fever, or  hepatitis  Acute liver disease therapy and
not interrupt therap  rash. of any etiology periodically thereafter
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

to detect possible
bacterial resistance.
 Monitor BP during
period of dosage
adjustment. Some
experience orthostatic
hypotension;
therefore, caution
against rapid positional
changes.
 Monitor diabetics for
loss of glycemic
control.
 Check weight at least
twice weekly under
standard conditions.

ETHIONAMIDE TRECATOR For use in the Adult:  Abdominal or  metallic  Hypersensitivity to  Perform C&S prior to
treatment of Give with meals to stomach pain taste, ethionamide and start of therapy.
pulmonary and minimize GI upset.  diarrhea  stomatitis, chemically related Baseline liver function
extrapulmonary Initially 250mg/day in  increased watering  anorexia, drugs [e.g., tests (AST and ALT),
tuberculosis when 1–4 divided doses; of the mouth  liver isoniazid, niacin CBC, and kidney
other titrate to highest  loss of appetite dysfunction, (nicotinamide)]; function tests including
antitubercular tolerated dose (see full  metallic taste  psychosis,  severe liver damage. urinalysis and every 2–
drugs have failed. labeling). Usual range:  swelling or  postural  Safety during 4 wk during therapy.
15–20mg/kg daily; max inflammation of hypotension, pregnancy (category  Report onset of skin
1g/day. the mouth  hypoglycemi D), lactation, or in rash. Progression to
Children:  weight loss a, children and women exfoliative dermatitis
Give with meals to  gynecomasti of childbearing can occur if drug is not
minimize GI upset. 10– a, potential is not promptly discontinued.
20mg/kg in 2–3 divided  impotence, established.  Monitor blood glucose
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

doses, or 15mg/kg once  acne; & HbA1c closely in the

daily.  optic diabetic until response
neuritis, to drug is established.
 visual These patients appear
disturbances, to be especially prone
 pellagra, to hepatotoxicity
 thrombocyto
penia.
ETHAMBUTOL MYAMBUTOL Adjunctive Adult:  loss of  Dermatitis  contraindicated in  Perform C&S
treatment for Give once daily. Initially appetite  Pruritus patients with prior to and
pulmonary 15mg/kg per day.  upset stomach  Joint Pain known optic periodically throughout
tuberculosis. Retreatment: 25mg/kg  vomiting  GI Upset neuritis unless therapy.
per day, after 60 days  numbness and  Confusion clinical judgment  Perform
decrease to 15mg/kg tingling in the  Peripheral determines that it ophthalmoscopic
per day. Renal hands or feet  Neuritis may be used. examination prior to
dysfunction: reduce  blurred vision  Gout Ethambutol is also and at monthly
dose.  inability to see  Reduced  contraindicated in intervals during
Children: the colors red Visual Acuity patients who are therapy. Test eyes
<13yrs: not and green  Optic unable to separately as well as
recommended.  sudden Neuritis appreciate and together.
changes in vision report visual side  Monitor I&O ratio in
 skin rash effects or changes in patients with renal
 itching vision (i.e., young impairment. Report
pediatric patients or oliguria or any
unconscious significant changes in
patients). ratio or in laboratory
reports of kidney
function. Systemic
accumulation with
toxicity can result from
delayed drug excretion.
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

 Perform liver and

kidney function tests,
CBC, and serum uric
acid levels at regular
intervals throughout
therapy.
CYCLOSERINE SEROMYCIN This medication is Active Tuberculosis  Confusion  convulsions, Contraindicated in  Culture and
used with  Adults, initial:  Restlessness  drowsiness, patient with: susceptibility tests
other medications t 250 mg orally every  Drowsiness  somnolence  Epilepsy. should be performed
o 12 hours for 14  Spinning sensa  tremor,  Depression. before initiation of
treat tuberculosis (T days THEN tion (vertigo)  dysarthria,  Severe anxiety. therapy and
B). In some cases, it  Adults: 500 mg  Irregular  vertigo,  Psychosis. periodically thereafter
may also be used to -1 g/day divided heartbeats  allergy  Severe renal to detect possible
treat urinary tract every 12 hours for (arrhythmia)  rash, insufficiency. bacterial resistance.
infections (UTIs). It 18-24 months; not  Folate deficien  elevated serum  Excessive Monitor plasma drug
works by stopping to exceed 1 g/day cy transaminase  concurrent use of levels weekly and
the growth of  Children: 10-20  Overactive alcohol. hematologic, renal, and
bacteria. mg/kg/day reflexes hepatic function at
orally in divided  Speech regular intervals.
doses up to 1 g/day disorder  Maintenance of blood-
for 18-24 months  Dizziness drug level below 30
 Monitor blood l  Headache mg/mL considerably
evels  Coma reduces incidence of
 Liver enzymes  neurotoxicity.
increased Possibility of
 Sleepiness neurotoxicity increases
 Weakness when dose is 500 mg or
 Seizure more or when renal
 Heart failure clearance is
inadequate.
 Observe patient
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

carefully for signs of

hypersensitivity and
neurologic effects.
Neurotoxicity generally
appears within first 2
wk of therapy and
disappears after drug is
discontinued.
 Drug should be with
held and physician
notified or dosage
reduced if symptoms of
CNS toxicity or
hypersensitivity
reaction 

COPD DRUGS

GENERIC NAME BRAND NAME INDICATIONS DOSAGE SIDE EFFECTS ADVERSE EFFECTS CONTRAINDICATIONS NURSING
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

CONSIDERATIONS
VARENICLINE CHANTIX Treatment of Adult:  nausea (may  Nausea,  History of  Be alert for signs
smoking cessation; Provide patients with persist for several  other GI serious of depression or
in conjunction with counseling and months), effects (eg, hypersensitivity or suicidal behaviors and
nonpharmacologic educational support.  stomach pain, constipation, skin reactions to ideology. Notify
support. Set a target "quit date".  indigestion, flatulence, CHANTIX physician immediately
Begin therapy 1 week  constipation, vomiting), Contrainidcated in if patient exhibits these
before target quit date.  gas,  sleep patient with: signs.
Alternatively, may  vomiting, disturbance (eg,  schizophrenia  Watch for signs
begin therapy and then  headaches, abnormal dreams,  manic- of anemia, including
quit smoking between  weakness, insomnia); depression unusual fatigue,
Days 8 and 35 of  tiredness,  nicotine  suicidal thoughts shortness of breath
treatment. Take after  unusual dreams, withdrawal  alcoholism with exertion, bruising,
eating with a glass of  sleep problems symptoms (due to  alcohol and pale skin. Notify
water. Initially 0.5mg (insomnia), smoking intoxication physician immediately
once daily on Days 1–3,  headache, dry cessation),  depression if these signs occur.
then 0.5mg twice daily mouth, or neuropsychiatric  a heart attack  Monitor signs of
on Days 4–7, then 1mg  unpleasant taste in symptoms (may  a sudden hypersensitivity
twice daily thereafter. your mouth. be serious), worsening of angina reactions, including
May reduce dose if  cardiovascula called acute coronary pulmonary symptoms
intolerable nausea or r events; seizures, syndrome (tightness in the throat
other adverse effects somnambulism,  angina and chest, wheezing,
occur. Treat for 12 angioedema,  a type of chest cough, dyspnea) or skin
weeks; may continue hypersensitivity pain reactions (rash,
12 more weeks if reactions, serious  a transient pruritus, urticaria).
patient successfully skin reactions ischemic attack Notify physician if these
stops smoking to (rare); discontinue  a type of stroke reactions occur.
further increase the if occurs.  Monitor anxiety,
that lasts only a few
likelihood of minutes irritability, restlessness,
abstinence. Patients  a stroke agitation, decreased
who are not able or attention, increased
 peripheral
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

willing to quit abruptly: vascular disease aggression,

consider a gradual  severe renal hyperactivity, and
approach; begin impairment other alterations in
Chantix dosing and  seizures mood or behavior.
reduce smoking by 50%  increased Notify physician
from baseline within cardiovascular event promptly if these
the 1st four weeks, by risk symptoms develop.
an additional 50% in  Assess any joint
the next four weeks, pain, back pain, or
and continue reducing muscle pain/cramps to
with the goal of rule out
complete abstinence by musculoskeletal
12 weeks; continue for pathology; that is, try
a total of 24 weeks of to determine if pain is
treatment. If patient drug induced rather
motivated to quit and than caused by
did not succeed, anatomic or
encourage another biomechanical
attempt with Chantix problems.
once factors  Assess dizziness
contributing to failed and syncope that might
attempt have been affect gait, balance, and
addressed. Severe renal other functional
impairment: initially activities (See Appendix
0.5mg once daily; may C). Report balance
titrate to max 0.5mg problems and
twice daily. ESRD with functional limitations to
hemodialysis: max the physician, and
0.5mg once daily if caution the patient and
tolerated. family/caregivers to
Children: guard against falls and
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

≤16yrs: not trauma.

recommended. 17–
19yrs: not established.

NORTRIPTYLINE PAMELOR Indicated: Adults  nausea  Drowsiness, Contraindicated in  Be aware that

 For the Initially, 25 mg to 50  drowsiness  anticholinerg patient with: nortriptyline has a
treatment mg PO per day, given in  weakness or ic effects,  Acute recovery narrow therapeutic
of divided doses or once tiredness  CNS period after MI; during plasma level range, or
major depr daily at bedtime. May  excitement or overstimulation, or within 14 d of MAO "therapeutic window."
ession be increased if needed anxiety  arrhythmias, inhibitor therapy. Drug levels above or
 For the and tolerated. Max:  nightmares  extrapyramid  Children <12 y, below the therapeutic
treatment 150 mg/day PO.  dry mouth al symptoms,  pregnancy window are associated
of social Geriatric Adults  changes in  hypo- or (category D), lactation. with decreased rate of
phobia Initially, 10 mg to 25 appetite or weight hypertension, response.
(social mg PO at bedtime. May  constipation  nausea,  Therapeutic
anxiety increase as tolerated to  difficulty urinating  changes in response may not
disorder) or 30 mg to 50 mg per  frequent urination blood sugar, occur for 2 wk or more.
panic day, in divided doses or  changes in sex  photosensitiv  Monitor BP and
disorder once daily at bedtime. drive or ability ity, edema, pulse rate during
 For the Adolescents  excessive sweating  blood adjustment period of
treatment Initially, 10 mg or 25 dyscrasias, TCA therapy. If systolic
of mg PO at bedtime. May  jaundice. BP falls more than 20
premenstru increase as tolerated to mm Hg or if there is a
al dysphoric 30 mg to 50 mg per sudden increase in
disorder day, given in divided pulse rate, withhold
(PMDD) doses or once daily at medication and notify
 For the bedtime. Tricyclic the physician.
treatment antidepressants are not  Notify physician if
of nocturna drugs of choice for psychotic signs
l enuresis pediatric patients with increase. Because of
 For the depression; the quality the small therapeutic
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

treatment of data to support window, a substitute

of efficacy and safety in TCA may be prescribed
postherpeti adolescents is rather than an increase
c neuralgia considered marginal. in dosage.
 Inspect oral
membranes daily if
patient is on high doses
of TCA. Urge outpatient
to report stomatitis or
dry mouth. Sore mouth
can be a major cause of
poor nutrition and
noncompliance.
Consult physician about
use of a saliva
substitute (e.g., VA-
Oralube, Moi-Stir).
 Monitor bowel
elimination pattern and
I&O ratio. Urinary
retention and severe
constipation are
potential problems,
especially in older
adults. Advise
increased fluid intake;
consult physician about
stool softener.
 Observe patient
with history of
glaucoma. Symptoms
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

that may signal acute

attack (severe
headache, eye pain,
dilated pupils, halos of
light, nausea, vomiting)
should be reported
promptly.
 Report reduction
or alleviation of fine
tremors.
 Be aware that
alcohol potentiation
may increase the
danger of overdosage
or suicide attempt.

CLONIDINE CATAPRES Catapres is a Adults  dry mouth,  withdrawal Contraindicated in  Monitor BR

prescription Initially, 0.1 mg PO  dizziness, symptoms, patient with: closely. Determine
medicine used to twice daily. Increase by  drowsiness,  nervousness,  Pregnancy positional changes
treat 0.1 mg/day at weekly  fatigue,  agitation, (category C), lactation. (supine, sitting,
symptoms high intervals until desired  constipation,  headache,  Use of clonidine standing).
blood effect is achieved (usual  headache,  tremor, and patch in polyarteritis  With epidural
pressure, attention range: 0.2 to 0.6  nausea, and  rapid rise in nodosa, scleroderma, administration,
deficit mg/day). For unequal  trouble sleeping blood pressure SLE. frequently monitor BP
hyperactivity doses, taking the larger (insomnia) and HR. Hypotension is
disorder (ADHD) portion of the daily a common side effect
and cancer pain. dose at bedtime may that may require
Catapres may be minimize adverse intervention.
used alone or with events. Although the  Monitor BP
other medications. manufacturer closely whenever a
Catapres belongs recommends a drug is added to or
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

to a class of drugs maximum dose of 2.4 withdrawn from

called Alpha2 mg/day, which is rarely therapeutic regimen.
Agonists, Central- used, further  Monitor I&O
Acting, ADHD antihypertensive during period of dosage
Agents. benefit may not be adjustment. Report
achieved at doses change in I&O ratio or
above 1.2 mg/day. change in voiding
Geriatric patients may pattern.
require a lower initial  Determine weight
dose due to increased daily. Patients not
risk of side effects. receiving a concomitant
Children and diuretic agent may gain
Adolescents 12 years weight, particularly
and older† during first 3 or 4 d of
Initially, 0.1 mg PO therapy, because of
twice daily titrated up marked sodium and
based on clinical water retention.
response (Max: 2.4  Supervise closely
mg/day). Increase by patients with history of
0.1 mg/day at weekly mental depression, as
intervals until desired they may be subject to
effect is achieved (usual further depressive
adult range: 0.2 to 0.6 episodes.
mg/day). For unequal
doses, taking the larger
portion of the daily
dose at bedtime may
minimize adverse
events.
Children younger than
12 years†
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

Generally not
recommended in
children younger than
12 years. Initial doses
of 5 to 10 mcg/kg/day
PO in divided doses
every 8 to 12 hours
then titrated based on
clinical response (Max:
25 mcg/kg/day or 0.9
mg/day) has been
reported.

BUPROPION FORFIVO XL FORFIVO XL Adult:  dry mouth,  Weight loss,  Hypersensitivity to  Monitor for
(bupropion Do not use for initiation  nausea,  weight gain.  bupropion; therapeutic
hydrochloride treatment; use other  insomnia,  CNS: Seizures. The  history of seizure effectiveness. The full
extended-release bupropion forms for  dizziness, risk of seizure disorder; antidepressant effect of
tablets) is indicated initial dose titration.  sore throat, appears to be  current or prior drug may not be
for the treatment Swallow whole. One  abdominal pain, strongly diagnosis of bulimia or realized for 4 or more
of major tab (450mg) once daily.  agitation, associated with anorexia nervosa; weeks.
depressive May be used in patients  anxiety, dose (especially  concurrent  Close observation
disorder (MDD), as receiving 300mg/day of  tremor, >450 mg/d) and administration of an for worsening of
defined by the another bupropion  heart palpitations, may be increased MAO inhibitor; depression or suicidal
Diagnostic and forms for at least 2  sweating, by predisposing  head trauma; tendencies.
Statistical Manual weeks and requiring a  ringing in the ears, factors (e.g., head  CNS tumor;  Use extreme
(DSM). 450mg/day dose. Taper  muscle pain, trauma, CNS  recent MI; caution when
dose using another  weight loss, tumor) or a abrupt discontinuation, administering drug to
bupropion form prior history of prior  anorexia nervosa, patient with history of
 urinary frequency,
to stopping Forfivo XL. seizure; agitation,  bulimia nervosa, seizures, cranial
 headache
Switching from other insomnia, dry  children <18 y; trauma, or other
or migraine,
bupropion forms at mouth, blurred factors predisposing to
 rash, lactation.
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

450mg/day: give  infection, vision, headache, seizures; during sudden

equivalent dose of  weakness/lack of dizziness, tremor. and large increments in
Forfivo XL once daily. energy,   GI: Nausea, dose, seizure potential
Switching to/from  chest pain, vomiting, is increased.
MAOIs: see full  flushing, constipation.   Report significant
labeling.  hot flashes,  CV: Tachycardia. S restlessness, agitation,
Children:  constipation, kin: Rash. anxiety, and insomnia.
Not established.  diarrhea, Symptoms may require
 vomiting, treatment or
 trouble discontinuation of drug.
swallowing,  Monitor for and
 joint pain, report delusions,
 nervousness, hallucinations,
 drowsiness, psychotic episodes,
 memory problems, confusion, and
 runny or stuffy paranoia.
nose,  Lab tests:
 cough, Monitor hepatic and
 itching, renal function tests
 hives, or while patient is taking
this drug.
 blurred vision.

PNEUMONIA DRUGS
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

GENERIC NAME BRAND NAME INDICATIONS DOSAGE SIDE EFFECTS ADVERSE EFFECTS CONTRAINDICATION NURSING
CONSIDERATION
SULFISOXAZOLE SULFAFURAZOLE This medication Administered orally  dizziness,  fever,  Contraindicated in  Lab tests: Obtain
is a sulfonamide (tablets)  headache  chills, patient with: a specimen for C&S
antibacterial,  Adults:  lethargy,  arthra  History of prior to initiation of
prescribed for Loading dose: 2-4  diarrhea, lgia, hypersensitivity to therapy. Perform
treating and grams  anorexia,  malai sulfonamides, frequent kidney
preventing Maintenance dose: 4-8  nausea, se, salicylates, or function tests and
certain bacterial grams per day in 4-6  vomiting, and  allergi chemically related urinalyses; complete
infections. It divided doses  serious c myocarditis, drugs; blood counts and liver
helps keep Children (>2 months): skin rashes.  seru  use in treatment function tests,
bacteria from Initial dose: 75mg/kg m sickness,  of group A beta- especially during
growing in the Maintenance dose:  anaph hemolytic regimens longer than 2
body. 150mg/kg/day in 4-6 ylactoid reactions, streptococcal wk.
divided doses  lymph infections;  Monitor I&O.
(maximum of 6 grams adenopathy  infants <2 mo of Report oliguria and
per day)  local age (except in changes in I&O ratio.
reaction following treatment of Fluid intake should be
IM injection, congenital adequate to support
 fixed toxoplasmosis); urinary output of at
drug eruptions, porphyria; least 1500 mL/d to
 diures  advanced prevent crystalluria and
is, kidney or liver stone formation.
 overg disease; intestinal  Check urine pH
rowth of and urinary daily with Nitrazine
nonsusceptible obstruction; paper or Labstix; fall in
organisms,  pregnancy urinary pH (more
 LE (category B, acidic) increases risk of
phenomenon.  category D if near crystalluria.
term),  Report increasing
 lactation urine acidity. If urine is
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

highly acidic, physician

may prescribe a urinary
alkalinizer.
 Monitor
temperature. Sudden
appearance of fever
may signify
sensitization (serum
sickness) or hemolytic
anemia (frequent in
patients with G6PD
deficiency, which is
most common among
black males and
Mediterranean ethnic
groups). Reactions
generally develop
within 10 d.
Agranulocytosis may
develop after 10 d–6
wk of therapy.
 Report early
manifestations of blood
dyscrasias or
hypersensitivity
reactions immediately
(fever with sore throat,
malaise, unusual
fatigue, joint pains,
pallor, bleeding
tendencies, rash,
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

jaundice).
 Be alert for skin
lesions, papular or
vesiculobullous lesions,
especially on sun-
exposed areas,
Stevens-Johnson
syndrome (severe
erythema multiforme)
may be preceded by
high fever, severe
headache, stomatitis,
conjunctivitis, rhinitis,
urticaria, balanitis
(inflammation of penis
or clitoris). Termination
of drug therapy is
indicated.
 Observe diabetic
patients receiving oral
hypoglycemic agents
closely for
hypoglycemic
reactions. Obtain blood
glucose and HbA1c
levels before and
shortly after initiation
of therapy.

FLUCONAZOLE DIFLUCAN indicated in Oropharyngeal Candid  headache  Nausea, Contraindicated in  Monitor for

adults for the iasis  diarrhea  headache, patient with: allergic response.
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

prophylaxis of: Adult: 200 mg orally on  nausea  rash,  Hypersensitivity to Patients allergic to
Relapse of Day 1, THEN 100 mg or upset stomach  vomiting, fluconazole or other other azole antifungals
cryptococcal once/day  dizziness  abdominal pain, azole antifungals; may be allergic to
meningitis in Pediatric: 6 mg/kg  stomach pain  diarrhea,  pregnancy (category fluconazole.
patients with orally on Day 1, THEN 3  vomiting  dizziness; C),  Lab tests:
high risk of mg/kg once/day; not to  changes in the  hepatotoxicity,  lactation. Monitor BUN, serum
recurrence. exceed 600 mg/day way food tastes  adrenal creatinine, and liver
Relapse of Esophageal Candidiasi  severe rash in insufficiency; function.
oropharyngeal s people with lowered  rare: anaphylaxis,  Note: Drug may
or Adult: 200 mg orally on immunity exfoliative cause elevations of the
oesophageal ca Day 1, THEN 100 mg dermatitis, following laboratory
ndidiasis in once/day; doses up to  QT prolongation, serum values: ALT, AST,
patients 400 mg/day may be  Torsade de alkaline phosphatase,
infected with used based on patient's pointes. bilirubin.
HIV who are at response  Monitor for S&S
high risk of Pediatric: 6 mg/kg of hepatotoxicity.
experiencing orally on Day 1, THEN 3  Monitor carefully
relapse. mg/kg once/day for loss of glycemic
Cryptococcal Meningi control if diabetic.
tis  Inform physician
Adult of all medications being
400 mg orally on Day 1, taken.
THEN 200 mg orally
once/day
Dosage of up to 400 mg
once/day may be used
based on patient's
response
Suppression of
relapse in patients
with AIDS: 200 mg
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

orally once/day
Vaginal Candidiasis
Uncomplicated: 150 mg
orally as a single dose
Complicated: 150 mg
orally every 72 hours
for 3 doses
Recurrent: 150 mg
orally once/day for 10-
14 days followed by
150 mg once weekly for
6 months
Candida UTI/Peritoniti
s
50-200 mg orally
once/day
Systemic Candida
Infections, Pediatric
6-12 mg/kg/day
orally/intravenously
(IV); not to exceed 600
mg/da

AMPHOTERICIN ABELCET Invasive fungal Adults and Children:  injection site  Body as a Contraindicated in  Notify physician if
B infections in 5mg/kg daily as a single reactions (pain, Whole: Hypersens patients with: improvement does not
patients who IV infusion, at a rate of swelling, irritation), itivity (pruritus,  Hypersensitivity to occur within 1–2 wk or
are refractory 2.5mg/kg per hour.  fever, urticaria, skin amphotericin. if lesions appear to
to, or intolerant Renal impairment:  shaking, rashes, fever, worsen. Nail infections
of, conventional reduce dose.  chills, dyspnea, anaphyl usually require several
amphotericin B  flushing, axis); fever, chills.  months or longer to
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

therapy.  loss of  CNS: Headache, improve.

appetite, sedation, muscle  Wash towels and
 weight loss, pain, arthralgia, clothing that were in
 dizziness, weakness. contact with affected
 nausea,   CV: Hypotension,  areas after each
 vomiting, cardiac arrest.  treatment.
 diarrhea,  Special  Note: Topical
 upset Senses: Ototoxicit cream slightly discolors
stomach, y with tinnitus, the skin. Generally,
 headache, vertigo, loss of lotion and ointment do
 shortness of hearing. GI: nause not stain skin when
breath, a, vomiting, rubbed in, but nail
 muscle or joint diarrhea, lesions may be stained.
aches, epigastric cramps,  Do not breast
 warmth/redne anorexia, weight feed while taking this
ss/tingly feeling loss.  drug without
under your skin,  Hematologic: Ane consulting physician.
 itching or rash, mia,  Lab tests:
or thrombocytopeni Baseline C&S tests prior
 fast breathing a. to initiation of therapy;
1 to 3 hours after   Metabolic: Hypok start drug pending
the infusion starts. alemia, results. Baseline and
hypomagnesemia.  periodic BUN, serum
 Urogenital: Nephr creatinine, creatinine
otoxicity, urine clearance; during
with low specific therapy periodic CBC,
gravity.  serum electrolytes
 Skin: Dry, (especially K+, Mg++,
erythema, Na+, Ca++), and liver
pruritus, burning function tests.
sensation; allergic  Monitor for S&S
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

contact of local inflammatory

dermatitis, reaction or thrombosis
exacerbation of at injection site,
lesions.  particularly if
 Other: Pain; extravasation occurs.
arthralgias,  Monitor
thrombophlebitis cardiovascular and
(IV site), respiratory status and
superinfections. observe patient closely
for adverse effects
during initial IV
therapy. If a test dose
(1 mg over 20–30 min)
is given, monitor vital
signs every 30 min for
at least 4 h. Febrile
reactions (fever, chills,
headache, nausea)
occur in 20–90% of
patients, usually 1–2 h
after beginning
infusion, and subside
within 4 h after drug is
discontinued. The
severity of this reaction
usually decreases with
continued therapy.
Keep physician
informed.
 Monitor I&O and
weight. Report
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

immediately oliguria,
any change in I&O ratio
and pattern, or
appearance of urine
[e.g., sediment, pink or
cloudy urine
(hematuria)], abnormal
renal function tests,
unusual weight gain or
loss. Generally, renal
damage is reversible if
drug is discontinued
when first signs of
renal dysfunction
appear.

SULFAMETHOX BACTRIM Susceptible Adult:  loss of  Skin: Mild to Contraindicated in  Be aware that IV Septra
AZOLE infections 1 DS tab, 2 regular tabs, appetite, moderate rashes patients with: contains sodium
including UTIs or 20mL of susp every  nausea, (including fixed  History of drug- metabisulfite, which
(not for initial 12hrs for 5 days  vomiting, drug induced immune produces allergic-type
uncomplicated (shigellosis, travelers'  painful eruptions), toxic thrombocytopenia reactions in susceptible
episodes), diarrhea), or 10–14 or swollen tongue, epidermal with use of patients: Hives, itching,
shigellosis, days (UTIs), or 14 days  dizziness, necrolysis.  trimethoprim wheezing, anaphylaxis.
prophylaxis and (bronchitis). PJP  spinning  GI: Nausea, and/or Susceptibility (low in
treatment treatment: 15– sensation, vomiting, diarrhea sulfonamides. general population) is
of Pneumocystis 20mg/kg per day of  ringing in your , anorexia, hepati  Megaloblastic seen most frequently in
jiroveci pneumo trimethoprim (75– ears, tis, pseudomembr anemia due to asthmatics or atopic
nia (PJP), 100mg/kg per day of  tiredness, or anous folate deficiency. nonasthmatic persons.
travelers' sulfamethoxazole) in 4  sleep enterocolitis,  Children <2 months.  Lab tests: Baseline and
diarrhea or divided doses at 6-hour problems stomatitis,  Marked hepatic followup urinalysis;
acute intervals for 14–21 (insomnia). glossitis, damage. CBC with differential,
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

exacerbations of days; PJP prophylaxis: abdominal pain.   Severe renal platelet count, BUN
chronic one DS tab daily. Renal  Urogenital: Kidne insufficiency when and creatinine
bronchitis in impairment (CrCl 15– y failure, oliguria, renal status cannot clearance with
adults, acute 30mL/min): reduce anuria, be monitored. prolonged therapy.
otitis media in dose by ½; (CrCl crystalluria.   Monitor coagulation
children. <15mL/min): not  Hematologic: Agr tests and prothrombin
recommended. anulocytosis (rare times in patient also
Children: ), aplastic receiving warfarin.
<2 months: see anemia (rare), Change in warfarin
Contraindications. megaloblastic dosage may be
≥2 months: 8mg/kg per anemia, indicated.
day trimethoprim hypoprothrombin  Monitor I&O volume
(40mg/kg per day of emia, and pattern. Report
sulfamethoxazole) in 2 thrombocytopeni significant changes to
divided doses at 12- a (rare).  forestall renal calculi
hour intervals for 5  Body as a formation. Also report
days (shigellosis) or 10 Whole: Weakness failure of treatment
days (otitis media, , arthralgia, (i.e., continued UTI
UTIs). PJP treatment: as myalgia, symptoms).
adult; PJP prophylaxis photosensitivity, a  Older adult patients are
or renal impairment llergic at risk for severe
myocarditis. adverse reactions,
especially if liver or
kidney function is
compromised or if
certain other drugs are
given. Most frequently
observed:
Thrombocytopenia
(with concurrent
thiazide diuretics);
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

severe decrease in
platelets (with or
without purpura); bone
marrow suppression;
severe skin reactions.
 Be alert for overdose
symptoms (no
extensive experience
has been reported):
Nausea, vomiting,
anorexia, headache,
dizziness, mental
depression, confusion,
and bone marrow
depression.

GATIFLOXACIN ZYMAXID Indicated in Usual Adult Dose for   mild nausea  Body as a Contraindicated in  Monitor for S&S
patients with: Pneumonia:  vomiting Whole: Headache patients with: of CNS disturbance
Acute bacterial Community-acquired:  stomach pain , allergic  Hypersensitivity to especially with history
exacerbation of 400 mg orally or IV  diarrhea reactions, chills, gatifloxacin or other of cerebrovascular
chronic once a day for 7 to 14  dizziness fever; back pain, quinolone disease or seizures.
bronchitis; days  restlessness chest pain.  antibiotics;  Lab tests: C&S
acute sinusitis; Adults and Children:  confusion  CNS: Dizziness,  pregnancy (category prior to initiation of
community- <1yr: not established.  vaginal abnormal dreams, C). therapy; WBC with
acquired ≥1yr: 1 drop every 2hrs discharge or itching insomnia, differential.
pneumonia; in affected eye(s) while  sleep paresthesia,  Monitor diabetics
uncomplicated awake (max 8 doses) problems (insomnia tremor, for loss of glycemic
or complicated on day 1, then 1 drop in or nightmares), or vasodilatation, control.
UTI; affected eye(s) 2–4  headache vertigo.  Monitor for
pyelonephritis; times daily while awake  CV: Palpitation; changes in digoxin
gonorrhea due on days 2–7. peripheral blood levels with
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

to susceptible edema.  coadministered drugs.

organisms.  GI: Nausea,  Be aware that
diarrhea, increased risk of
abdominal pain, seizures are associated
constipation, with drug use in patient
dyspepsia, with history of seizures.
glossitis, oral  Report
moniliasis, unexplained dizziness
stomatitis, or problems with
vomiting.  balance, severe
 Respiratory: Dysp diarrhea, skin rash,
nea, pharyngitis.  mental status changes.
 Skin: Rash,  Do not breast
sweating.  feed while taking this
 Urogenital: Vagini drug without
tis, dysuria, consulting physician.
hematuria. 
 Special
Senses: Abnormal
vision, taste
perversion,
tinnitus. 
 Metabolic: Hyper
glycemia,
hypoglycemia. 
 Other: Cartilage
erosion.
MOXIFLOXACIN AVELOX Susceptible Adult:  nausea  CNS: Dizziness,  Hypersensitivity to  Monitor
infections ≥18yrs: 400mg once  diarrhea headache, moxifloxacin or therapeutic
including acute daily. ABS: treat for 10  headache peripheral other quinolones; effectiveness indicated
bacterial days. ABECB: treat for 5  vomiting neuropathy.   moderate to severe by clinical
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

sinusitis (ABS), days. Pneumonia: treat  dizziness  GI: Nausea, hepatic improvement of

acute bacterial for 7–14 days. Skin and  nervousness diarrhea, insufficiency; infection.
exacerbations of skin structure: treat for  agitation abdominal pain, syphilis;  Monitor for and
chronic 7 days, if complicated:  nightmares vomiting, taste  pregnancy (category notify physician
bronchitis 7–21 days. Intra- perversion, C); immediately of adverse
(ABECB), abdominal: treat for 5– abnormal liver  lactation; patients CNS effects.
community 14 days. Plague: treat function tests, with history of  Notify physician
acquired for 10–14 days; begin dyspepsia. prolonged immediately for S&S of
pneumonia, skin as soon as possible  Musculoskeletal:  QTC interval on ECG, hypersensitivity.
and skin after suspected or Tendon rupture,  history of  Lab tests: C&S
structure, confirmed exposure. IV cartilage erosion. ventricular before initiation of
complicated formulation may be arrhythmias, atrial therapy and baseline
intra-abdominal used if oral route not fibrillation, serum potassium with
infections, preferable; administer hypokalemia, history of hypokalemia.
plague. For ABS IV infusion over bradycardia, acute  Exercise care in
and ABECB: 60mins, may switch myocardial timing of consumption
reserve for from IV to oral route ischemia, acute MI, of vitamins and
those who have when clinically patients receiving antacids
no alternative indicated. Class IA or Class III (see ADMINISTRATION)
treatment Children: antiarrhythmic .
options. <18yrs: not drugs; tendon pain;  Drink fluids
established.  viral infection; liberally, unless
torsade de pointes; directed otherwise.
 ocular preparation  Increased seizure
use in children <1 y. potential is possible,
especially when history
of seizure exists.
 Stop taking drug
and notify physician if
experiencing
palpitations, fainting,
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

skin rash, severe

diarrhea, ankle/foot
pain, agitation,
insomnia.
 Avoid engaging in
hazardous activities
until reaction to drug is
known.
 Do not breast
feed while taking this
drug.

LEVOFLOXACIN LEVAQUIN Susceptible Adult:  nausea  Nausea, Contraindicated in  Lab tests: Do C&S
bacterial ≥18yrs (CrCl  headache  headache, patient with: test prior to beginning
infections ≥50mL/min): Regimen  diarrhea  diarrhea,  Hypersensitivity to therapy and
including acute depends on pathogen  insomnia  insomnia, levofloxacin and periodically.
bacterial type (see full labeling). (trouble sleeping)  constipation, quinolone  Withhold therapy
sinusitis (ABS), Oral soln: take on  constipation  dizziness; antibiotics; and report to physician
acute bacterial empty stomach. IV:  dizziness  tendinitis/tendon  hypokalemia, immediately any of the
exacerbations of infuse over 60 mins rupture,  tendon pain, following: Skin rash or
chronic (250mg or 500mg), or  peripheral  pregnancy (category other signs of a
bronchitis over 90 mins (750mg). neuropathy, C); hypersensitivity
(ABECB), ABS: 500mg once daily  CNS effects,  syphilis; viral reaction; (CNS
nosocomial or for 10–14 days or hypersensitivity infections; symptoms such as
community- 750mg once daily for 5 reactions,  phototoxicity; seizures, restlessness,
acquired days. ABECB: 500mg hepatotoxicity, C.  lactation. confusion,
pneumonia once daily for 7 days. difficile-associated hallucinations,
(CAP), UTIs, Nosocomial diarrhea, torsades depression; skin
acute pneumonia: 750mg de pointes, eruption following sun
pyelonephritis, once daily for 7–14 dysglycemia, exposure; symptoms of
chronic bacterial days. CAP: 500mg once phototoxicity, colitis such as
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

prostatitis, skin daily for 7–14 days or aortic persistent diarrhea;

and skin 750mg once daily for 5 aneurysm/dissecti joint pain,
structure days. Uncomplicated on. inflammation, or
infections. skin and skin structure:  Children: also rupture of a tendon;
Inhalation 500mg once daily for musculoskeletal hypoglycemic reaction
anthrax (post- 7–10 days; disorders. in diabetic on an oral
exposure): to complicated: 750mg hypoglycemic agent.
reduce once daily for 7–14  Learn important
incidence or days. Prostatitis: 500mg indications for
progression of once daily for 28 days. discontinuing drug and
disease (see full Uncomplicated UTIs: immediately notifying
labeling). 250mg once daily for 3 physician.
Plague. For ABS, days. Complicated UTIs,  Consume fluids
ABECB, and acute pyelonephritis: liberally while taking
uncomplicated 250mg once daily for levofloxacin.
UTIs: reserve for 10 days or 750mg once  Allow a minimum
those who have daily for 5 days. of 2 h between drug
no alternative Postexposure dosage and taking any
treatment inhalational anthrax: of the following:
options. 500mg once daily for Aluminum or
60 days (start as soon magnesium antacids,
as possible after iron supplements,
exposure). Plague: multivitamins with zinc,
500mg once daily for or sucralfate.
10–14 days. Renal  Avoid exposure
impairment (CrCl to excess sunlight or
<50mL/min): adjust artificial UV light.
dose.  Avoid NSAIDs
Children: while taking
<6mos: not established. levofloxacin, if possible.
≥6mos: Inhalation  Do not breast
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

anthrax (post– feed while taking this

exposure): <30kg: use drug.
other forms; 30–<50kg:
250mg every 12hrs for
60 days; ≥50kg: 500mg
once daily for 60 days.
Plague: <30kg: use
other forms; 30–<50kg:
250mg every 12hrs for
10–14 days; ≥50kg:
500mg once daily for
10–14 days.

CLARITHROMYC BIAXIN Mild to Adult:  diarrhea.  Abdominal pain,  Hypersensitivity to  Inquire about previous
IN moderate Pharyngitis/tonsillitis:  nausea.  diarrhea, clarithromycin, hypersensitivity to
susceptible 250mg every 12hrs for  vomiting.  nausea, erythromycin, or other macrolides (e.g.,
pharyngitis/tons 10 days. Bronchitis:  stomach pain.  vomiting, any other macrolide erythromycin) before
illitis, acute 250mg–500mg every  heartburn.  dysguesia; antibiotics; treatment.
bacterial 12hrs for 7–14 days.  gas.  hepatotoxicity,  patients receiving  Withhold drug and
exacerbation of CAP, skin and skin  change in  QT prolongation,  pimozide; suspected notify physician, if
chronic structures: 250mg taste.  C. difficile- or potential hypersensitivity occurs
bronchitis, every 12hrs for 7–14  headache. associated bacteremias; acute (e.g., rash, urticaria).
community- days. Sinusitis: 500mg diarrhea, porphyria; severe  Monitor for and report
acquired every 12hrs for 14  hypersensitivity hepatic or biliary loose stools or
pneumonia, days. MAC: 500mg reactions. disease; diarrhea, since
acute maxillary every 12hrs; continue  pregnancy (category pseudomembranous
sinusitis, acute indefinitely if C). Safety and colitis must be ruled
otitis media, improvement occurs.  efficacy in children out.
uncomplicated Severe renal <6 y not established.  When clarithromycin is
skin and skin impairment (CrCl given concurrently with
structure <30mL/min): reduce anticoagulants, digoxin,
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

infections. clarithromycin dose by or theophylline, blood

Disseminated M ½. When moderate or levels of these drugs
. intracellulare. severe renal may be elevated.
Treatment (with impairment and Monitor appropriate
other concomitant atazanavir serum levels and assess
antimycobacteri or ritonavir: reduce for S&S of drug toxicity.
als) and clarithromycin dose by
prophylaxis of ½ (CrCl 30–60mL/min)
disseminated M or ¾ (CrCl <30mL/min).
ycobacterium Children:
avium complex <6 months: not
(MAC). established. Otitis
media,
pharyngitis/tonsillitis,
pneumonia, sinusitis,
skin and skin
structures: 7.5mg/kg
every 12hrs for 10
days. MAC (see full
labeling): 7.5mg/kg
every 12hrs; max
500mg every 12hrs,
continue indefinitely if
improvement occurs.

AZITHROMYCIN ZITHROMAX Mild-to- Adult:  diarrhea or  Diarrhea, Contraindicated in  Monitor for and
moderate Use packets only for loose stools,  nausea, patient with: report loose stools or
susceptible doses equal to 1g.  nausea,  abdominal pain,  Ketolide allergy. diarrhea, since
infections COPD: 500mg once  abdominal  vomiting, r History of cholestatic pseudomembranous
including acute daily for 3 days; or pain,  ash; jaundice/hepatic colitis (see Appendix F)
bacterial 500mg once for 1 day,  stomach  hepatotoxicity, dysfunction must be ruled out.
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

exacerbations of then 250mg once daily upset,  torsade de associated with  Monitor PT and
COPD, acute for 4 days. Sinusitis:  vomiting, pointes (esp. prior use. INR closely with
bacterial 500mg once daily for 3  constipation, elderly), C. concurrent warfarin
sinusitis, acute days. Community-  dizziness, difficile associated use.
otitis media, acquired pneumonia,  tiredness, diarrhea;  Direct sunlight
community- pharyngitis/tonsillitis,  headache,  rare: allergic (UV) exposure should
acquired skin and skin structure:  vaginal reactions (eg, be minimized during
pneumonia, 500mg once for 1 day, itching or discharge, angioedema, therapy with drug.
pharyngitis/tons then 250mg once daily  nervousness, AGEP, Stevens-  Take aluminum
illitis, for 4 days.  sleep problem Johnson or magnesium antacids
uncomplicated Nongonococcal s (insomnia), syndrome, toxic 2 h before or after
skin and skin urethritis, cervicitis,  skin rash or itc epidermal drug.
structure, chancroid: 1g as a hing, necrolysis,  Report onset of
urethritis, single dose. Urethritis,  ringing in the DRESS), lab loose stools or
cervicitis, cervicitis due to N. ears, abnormalities. diarrhea.
chancroid in gonorrhoeae: 2g as a  hearing  Do not breast
men. Treatment single dose. MAC problems, feed while taking this
and prophylaxis prevention (alone or  or drug without
of Mycobacteriu combined with decreased sense of consulting physician.
m rifabutin): 1200mg taste or smell.
avium complex once weekly. MAC
(MAC) infection treatment (combined
with ethambutol):
600mg once daily.
Children:
Use oral susp (not
packets). Otitis media:
<6mos: not established;
≥6mos: 30mg/kg as a
single dose (max 1.5g);
or 10mg/kg (max
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

500mg) once daily for 3

days; or 10mg/kg (max
500mg) once then
5mg/kg (max 250mg)
per day for 4 days.
Sinusitis: <6mos: not
established; ≥6mos:
10mg/kg (max 500mg)
once daily for 3 days.
Community-acquired
pneumonia: <6mos:
not established; ≥6mos:
10mg/kg (max 500mg)
once for 1 day, then
5mg/kg (max 250mg)
once daily for 4 days.
Pharyngitis/tonsillitis:
<2yrs: not established;
≥2yrs: 12mg/kg (max
500mg) once daily for 5
days.

ERYTHROMYCI ERYTHROCIN Treatment of Adult:  Blistering,  GI: Nausea,  Hypersensitivity to  Report onset of

N susceptible Give preferably 2hrs peeling, or vomiting, erythromycins.  GI symptoms after PO
infections before meals. Usual loosening of the skin abdominal  Estolate: History of administration to
including upper dose: 333mg every 8hrs  chills cramping, diarrhe erythromycin- physician. These are
and lower or 500mg every 12hrs;  cough a, heartburn, associated hepatitis; dose related; if
respiratory, skin max 4g/day (1g/day for  diarrhea anorexia.  liver dysfunction; symptoms persist after
and skin twice daily dosing).  difficulty with  Body as a treatment of skin dosage reduction,
structure, Legionnaires: 1–4g swallowing Whole: Fever, disorders such as physician may
genitourinary, daily in divided doses.  dizziness eosinophilia, acne or prescribe drug to be
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

Legionnaires' Prophylaxis: 250mg  fast heartbeat urticaria, skin furunculosis; given with meals in
disease, twice daily.  hives or welts,  eruptions, fixed prophylaxis of spite of impaired
pertussis, Children: skin rash drug eruption, rheumatic fever. absorption.
listeriosis. Give preferably 2hrs  joint or muscle anaphylaxis.  Monitor for
Prophylaxis for before meals. Usual pain Superinfections adverse GI effects.
rheumatic fever dose: 30–50mg/kg/day  puffiness or by nonsusceptible Pseudomembranous
attacks in in divided doses; may swelling of the bacteria, yeasts, enterocolitis (see
penicillin- double dose in severe eyelids or around or fungi.  Appendix F), a
allergic patients. infections. Max 4g/day. the eyes, face, lips,  Special potentially life-
or tongue Senses: Ototoxicit threatening condition,
 red, irritated y: reversible may occur during or
eyes bilateral hearing after antibiotic therapy.
 red skin loss, tinnitus,  Observe for S&S
lesions, often with a vertigo. of superinfection by
purple center   Digestive: (Estola overgrowth of
 redness of the te) Cholestatic nonsusceptible
skin hepatitis bacteria or fungi.
 sore throat syndrome.  Emergence of resistant
 sores, ulcers,  Skin: (topical use) staphylococcal strains
or white spots in the Erythema, is highly predictable
mouth or on the lips desquamation, during prolonged
 tightness in burning, therapy.
the chest tenderness,  Lab tests:
 unusual dryness or Periodic liver function
tiredness or oiliness, pruritus. tests during prolonged
weakness therapy.
 Monitor for S&S
of hepatotoxicity.
Premonitory S&S
include: Abdominal
pain, nausea, vomiting,
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

fever, leukocytosis, and

eosinophilia; jaundice
may or may not be
present. Symptoms
may appear a few days
after initiation of drug
but usually occur after
1–2 wk of continuous
therapy. Symptoms are
reversible with prompt
discontinuation of
erythromycin.
 Monitor for
ototoxicity that
appears to develop
most frequently in
patients receiving 4 g/d
or more, older adults,
female patients, and
patients with kidney or
liver dysfunction. It is
reversible with prompt
discontinuation of
drug.

CLAVULANIC AUGMENTIN XR Susceptible Adult:  diarrhea  GI: Diarrhea, naus  Combination shares  Determine previous
ACID infections Take with meals. May  upset stomach ea, vomiting.  toxic potential of hypersensitivity
including split scored tabs; do  vomiting  Skin: Rash, ampicillin. reactions to penicillins,
community- not reduce dose. Two  mild skin rash urticaria.   Hypersensitivity to cephalosporins, and
acquired Augmentin 500mg tabs  severe skin  Other: Candidal penicillins; other allergens prior to
pneumonia and are not equivalent to rash vaginitis;  infectious therapy.
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

acute bacterial one XR tab. ≥16yrs: 2  itching moderate mononucleosis.  Lab tests: Baseline C&S
sinusitis  tabs every 12 hrs.  hives increases in tests prior to initiation
Sinusitis: treat for 10  difficulty serum ALT, AST; of therapy; start drug
days. CAP: treat for 7– breathing or glomerulonephriti pending results.
10 days. swallowing s; agranulocytosis   Monitor for S&S of an
Children:  wheezing (rare). urticarial rash (usually
<16yrs: not  vaginal itching occurring within a few
recommended. and discharge days after start of drug)
 yellowing of suggestive of a
the skin or eyes hypersensitivity
reaction. If it occurs,
look for other signs of
hypersensitivity (fever,
wheezing, generalized
itching, dyspnea), and
report to physician
immediately.
 Note: Generalized,
erythematous,
maculopapular rash
(ampicillin rash) is not
due to hypersensitivity.
It is usually mild, but
can be severe. Report
onset of rash to
physician, since
hypersensitivity should
be ruled out.

AMOXICILLIN AMOXIL Susceptible Adult:  diarrhea  GI upset,  Hypersensitivity to  Determine previous

infections ENT, genitourinary, or  stomach upset  hypersensitivity penicillins; hypersensitivity
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

including skin: 250mg every 8hrs.  headache reactions (eg,  infectious reactions to penicillins,
ear/nose/throat Severe, less  abnormal urticaria, rash, mononucleosis. cephalosporins, and
(ENT), susceptible, or lower taste sense Stevens-Johnson other allergens prior to
genitourinary respiratory infections:  skin rash syndrome, therapy.
tract, skin and 500mg every 8hrs.  vaginal yeast anaphylaxis),  Lab tests: Baseline C&S
skin structures, Gonorrhea: 3g once. infection  hyperactivity, tests prior to initiation
lower Renal impairment: blood dyscrasias. of therapy, start drug
respiratory, glomerular filtration pending results;
acute rate (GFR) 10– periodic assessments
uncomplicated 30mL/min: 250mg or of renal, hepatic, and
gonorrhea. 500mg every 12hrs; hematologic functions
GFR <10mL/min or should be made during
hemodialysis: 250mg or prolonged therapy.
500mg every 24hrs  Monitor for S&S of an
(give additional dose urticarial rash (usually
during and at end of occurring within a few
dialysis). days after start of drug)
Children: suggestive of a
≥40kg: as adult. ≤3 hypersensitivity
months: max 30mg/kg reaction. If it occurs,
per day in 2 divided look for other signs of
doses every 12hrs. >3 hypersensitivity (fever,
months (<40kg): ENT, wheezing, generalized
genitourinary, skin: itching, dyspnea), and
20mg/kg per day in 3 report to physician
divided doses every immediately.
8hrs. Severe, less  Report onset of
susceptible, or lower generalized,
respiratory infections: erythematous,
40mg/kg per day in 3 maculopapular rash
divided doses every (ampicillin rash) to
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

8hrs. Gonorrhea: <2yrs: physician. Ampicillin

not recommended; rash is not due to
prepubertal: amoxicillin hypersensitivity;
50mg/kg + probenecid however,
25mg/kg as a single hypersensitivity should
dose. be ruled out.
 Closely monitor
diarrhea to rule out
pseudomembranous
colitis.

PENICILLIN BICILLIN C-R Susceptible Adults and Children:  nausea  Rash,  Hypersensitivity to  Obtain an exact
moderately Give by deep IM inj into  vomiting  drug fever, any of the penicillins history of patient's
severe upper, outer buttock  stomach upset  serum sickness, or cephalosporins; previous exposure and
infections (dorsogluteal) or  diarrhea  anaphylaxis, administration of sensitivity to penicillins
including ventrogluteal site; for  black hairy  blood dyscrasias, oral drug to patients and cephalosporins and
respiratory, skin younger children, tongue  neuropathy, with severe other allergic reactions
and soft tissue, midlateral thigh may be  nephropathy, infections; nausea, of any kind prior to
erysipelas, preferred. Group A  in site reactions, vomiting, treatment with
scarlet fever, strep: <30lbs: 600,000  methemoglobine hypermotility, penicillin.
otitis media. units; 30–60lbs: mia, C. gastric dilatation;  Hypersensitivity
900,000–1.2 million  difficile-associated cardiospasm. reactions are more
units; >60lbs: 2.4 diarrhea.  Use of penicillin G likely to occur with
million units; all as sodium in patients parenteral penicillin
single dose (may split on sodium but may also occur
injections) or may give restriction. Safety with the oral drug. Skin
one-half total dose on during pregnancy rash is the most
day 1 and one-half on (category B) or common type allergic
day 3. Pneumococcal lactation is not reaction and should be
(except meningitis) established. reported promptly to
children: 600,000 units; physician.
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

adults 1.2 million units;  Lab tests:

give every 2–3 days Perform C&S tests prior
until afebrile for 48hrs. to initiation of therapy;
treatment may be
started before results
are known. Evaluate
renal, hepatic, and
hematologic systems at
regular intervals in
patients on high-dose
therapy. Additionally,
check electrolyte
balance periodically in
patients receiving high
parenteral doses.
 Observe all
patients closely for at
least 30 min following
administration of
parenteral penicillin.
The rapid appearance
of a red flare or wheal
at the IM or IV injection
site is a possible sign of
sensitivity. Also suspect
an allergic reaction if
patient becomes
irritable, has nausea
and vomiting,
breathing difficulty, or
sudden fever. Report
Camilo, Dexter M. RESPIRATORY DRUGS
BSN III-2

any of the foregoing to

physician immediately.
 Be aware that
reactions to penicillin
may be rapid in onset
or may not appear for
days or weeks.
Symptoms usually
disappear fairly quickly
once drug is stopped,
but in some patients
may persist for 5 d or
more and require
hospitalization for
treatment.