Drug Study - Perez, JH

RESPIRATORY DRUGS
TUBERCULOSIS DRUGS
Drug Indication Dosage Side Effects Adverse Contraindicat Nursing
Effect ion Consideration
Generic Name Tab: Treatment of Tab Adult & The more CNS: fever. Known • Systemic drug
MOXIFLOXACI upper & lower resp children ≥18 yr 1 common side EENT: hypersensitivit may cause serious
N tract infections eg, tab once daily. IV effects of conjunctivitis, y to hypersensitivity
HYDROCHLORI acute sinusitis, acute infusion 400 mg moxifloxacin dry eyes, moxifloxacin reactions. If
DE exacerbations of once daily (infused include: increased or other allergic reaction
chronic bronchitis, over 60 min). nausea lacrimation, quinolones or occurs, stop drug
community-acquired Duration of diarrhea keratitis, any of the and treat
Brand Name pneumonia, treatment for acute headache ocular excipients of symptoms.
AVELOX, uncomplicated & exacerbation of vomiting discomfort, Avelox. • Monitor patient
MOXEZA, complicated skin & chronic bronchitis: dizziness pain, or Pregnancy and for superinfection.
VIGAMOX, skin structure infections 5 days; nervousness pruritus, otitis lactation. • Solution isn’t for
AVELOX I.V. (diabetic foot community- agitation media, Patients <18 injection
infections), acquired nightmares pharyngitis, years. subconjunctivally
uncomplicated pelvic pneumonia: 10 If these effects reduced Use in or into anterior
inflammatory disease, days (tab) 7-14 are mild, they visual acuity, pregnancy & chamber of the
complicated intra- days (IV infusion); may go away rhinitis, lactation: Avel eye. • Look alike–
abdominal infections acute sinusitis: 7 within a few subconjunctiv ox is sound alike: Don’t
including polymicrobial days; skin & soft days or a couple al contraindicated confuse Vigamox
infections eg, abscesses. tissues infections: 7 of weeks. If hemorrhage. in pregnant with Avonex.
IV Infusion: days; they’re more women.
Community-acquired uncomplicated severe or don’t As with other
pneumonia, pelvic go away, talk to quinolones,
complicated skin & inflammatory your doctor or moxifloxacin
skin structure disease: 14 days; pharmacist. has been
infections, complicated complicated intra- shown to cause
intra-abdominal abdominal lesions in the
infections including infections: 5-14 cartilage of the
polymicrobial days. weight bearing
infections eg, abscesses. joints of
immature
animals.
Preclinical
evidence
RESPIRATORY DRUGS
indicates that
small amounts
of
moxifloxacin
may be
secreted in
human milk.
There is no
data available
in lactating or
nursing
women.
Therefore, the
use of
moxifloxacin
in pregnancy
and nursing
mothers is
contraindicated
.
Generic Name Treatment for Bacterial Adults and children Gatifloxacin eye CNS: • • Solution isn’t for
GATIFLOXACI conjunctivitis caused by age 1 and older: drops may cause headache. Contraindicate injection
N Corynebacterium Instill 1 drop into side effects. Tell EENT: d in patients subconjunctivally
propinguum, affected eye every your doctor if conjunctival hypersensitive or into the anterior
Brand Name Streptococcus mitis, 2 hours while any of these irritation, to drug or other chamber of the
AGITIFLOX, Staphylococcus aureus, patient is awake, symptoms are increased quinolones. eye.
VENDIFLOX, Staphylococcus up to eight times severe or do not lacrimation, • Safety and • Systemic drug
ZYMAR, epidermidis, daily for 2 days. go away: keratitis, effectiveness in may cause serious
ZYMAXIS Streptococcus Then instill 1 drop red, irritated, papillary infants less hypersensitivity
pneumoniae, up to q.i.d. for 5 itchy, or teary conjunctivitis, than 1 year reactions. If
Haemophilus more days. eyes. chemosis, have not been allergic reaction
influenzae. Also to treat blurred vision. conjunctival established. occurs, stop drug
Bacterial conjunctivitis Adults and children eye pain. hemorrhage, • Use and treat
caused by S. mitis, S. age 1 and older: eye discharge. discharge, dry cautiously in symptoms.
RESPIRATORY DRUGS
aureus, S. epidermidis, Instill 1 drop swollen eyelids. eyes, eye pregnant or • Monitor patient
S. pneumoniae, H. Zymaxid into broken blood irritation, breastfeeding for superinfection.
influenzae affected eye every vessels in the eyelid edema, women. • Growth of
2 hours while eyes. pain, red resistant
patient is awake, headache. eyes, reduced organisms,
up to eight times unpleasant taste. visual acuity. including fungi,
on day 1. Then GI: taste may occur with
instill 1 drop two to disturbance. prolonged use.
four times daily Monitor patient
while patient is carefully
awake on days 2 to
7.
Generic Name Aminosalicylates are an Dosage Details The most Nausea, Hypersensitivit • Monitor for
PARA- effective antiinfective Oral common side vomiting, y to abrupt onset of
AMINOSALICY alone or in combined Tuberculosis effects of PAS diarrhoea, aminosalicylat fever, particularly
LIC ACID therapy and reduce Adult: 150 are persistent abdominal es, salicylates, during the early
serum cholesterol and mg/kg/day in 3-4 nausea, pain; thyroid or to weeks of therapy,
triglycerides by equally divided vomiting and goitre, compounds and clinical picture
Brand Name lowering LDL and doses Take with diarrhoea. If the hypoglycaemi containing para resembling that of
PASER VLDL. Others are listed acidic food (e.g. patient a; -aminophenyl infectious
in dosage. apple sauce, experiences pericarditis, groups (e.g., mononucleosis
yoghurt, orange fatigue, it may vasculitis; sulfonamides, (malaise, fatigue,
juice). be due to encephalopat certain hair generalized
Child: 200-300 hypothyroidism hy, fever, dyes), G6PD lymphadenopathy,
mg/kg/day in 3-4 (when the skin deficiency, use splenomegaly, sore
equally divided thyroid gland eruptions, of the sodium throat), as well as
doses. produces agranulocytos salt in patients minor complaints
insufficient is, haemolytic on sodium of pruritus, joint
Oral thyroid anaemia, restriction or pains, and
Crohn's disease hormone) leucopenia, CHF. Safety headache, which
Adult: 1.5 g/day caused by PAS. thrombocytop during strongly suggest
(unlabelled use). PAS may cause enia, pregnancy hypersensitivity;
hepatitis hepatitis, (category C) or report these
Rectal (inflammation of jaundice, lactation is not symptoms
RESPIRATORY DRUGS
Ulcerative colitis the liver), optic neuritis, established. promptly.

Adult: 2 g once a usually preceded eosinophilic • Monitor I&O and
day as an enema in by a rash or a pneumonia. encourage fluids.
patients who are fever. High
intolerant to concentrations of
sulphasalazine. drug are excreted
in urine, and this
can cause
crystalluria and
hematuria.
• Note: To
minimize
crystalluria, keep
urine neutral or
alkaline with
adjunctive drugs,
such as antacids or
with diet.
Generic Name Only in combination Tuberculosis Common side CNS: Paresth History of • Lab tests: Obtain
STREPTOMYCI with other Adult: IM 15 effects of esias toxic reaction C&S tests prior to
N antitubercular drugs in mg/kg up to 1 g/d Streptomycin (peripheral, or and periodically
treatment of all forms as single dose include: facial). hypersensitivit during course of
of active tuberculosis Geriatric: IM 10 nausea, Body as a y to therapy. In patients
Brand Name caused by susceptible mg/kg (max: 750 vomiting, Whole: Hyper aminoglycosid with impaired
STREPTOZ, organisms. Used alone mg/d) stomach upset, sensitivity es; labyrinthine kidney function,
BIOLAB or in conjunction with Child: IM 20–40 loss of appetite, angioedema, disease; frequent
STREPTOMYCI tetracycline for mg/kg/d up to 1 g/d spinning drug fever, myasthenia determinations of
N SULFATE, tularemia, plague, and as single dose sensation enlarged gravis; serum drug
brucellosis. Also used Infant: IM 10–15 (vertigo), lymph concurrent or concentrations and
with other antibiotics in mg/kg q12h injection site nodes, anaph sequential use periodic kidney
treatment of subacute Neonate: IM 10–20 reactions (pain, ylactic shock, of other and liver function
bacterial endocarditis mg/kg q24h irritation, and headache, neurotoxic or tests are advised
due redness), inability to nephrotoxic (serum
to Enterococci and Stre tingling or concentrate, agents; concentrations
RESPIRATORY DRUGS
ptococci(viridans prickling lassitude, pregnancy should not exceed

group) sensation in the muscular (category C); 25 mcg/mL in
and Haemophilus face, weakness, pai lactation. these patients).
influenzae and in rash, n and • Be alert for and
treatment fever, irritation at report immediately
of peritonitis, hives, and IM symptoms of
respiratory tract swelling site, superinfe ototoxicity (see
infections, granuloma (edema). ctions, Appendix F).
inguinale, and neuromuscula Symptoms are
chancroid when other r blockade, most likely to
drugs have failed. arachnoiditis. occur in patients
GI: Stomatitis with impaired
, kidney function,
hepatotoxicit patients receiving
y. high doses (1.8–2
Hematologic: g/d) or other
Blood ototoxic or
dyscrasias neurotoxic drugs,
(leukopenia, and older adults.
neutropenia, Irreversible
pancytopenia, damage may occur
hemolytic or if drug is not
aplastic discontinued
anemia, promptly.
eosinophilia). • Early damage to
Special vestibular portion
Senses: Labyr of eighth cranial
inthine nerve (higher
damage, audit incidence than
ory damage, auditory toxicity)
optic nerve is initially
toxicity manifested by
(scotomas). moderately severe
Respiratory: headache, nausea,
Respiratory vomiting, vertigo
depression. S in upright position,
RESPIRATORY DRUGS
kin: Skin difficulty in
rashes, reading,
pruritus, exfol unsteadiness, and
iative positive Romberg
dermatitis. sign.
Urogenital: N • Be aware that
ephrotoxicity. auditory nerve
CNS: Enceph damage is usually
alopathy, CN preceded by
S depression vestibular
syndrome in symptoms and
infants high-pitched
tinnitus, roaring
noises, impaired
hearing (especially
to high-pitched
sounds), sense of
fullness in ears.
Audiometric test
should be done if
these symptoms
appear, and drug
should be
discontinued.
Hearing loss can
be permanent if
damage is
extensive. Tinnitus
may persist several
days to weeks after
drug is stopped.
• Monitor I&O.
Report oliguria or
changes in I&O
ratio (possible
signs of
RESPIRATORY DRUGS
diminishing kidney
function).
Sufficient fluids to
maintain urinary
output of 1500
mL/24 h are
generally advised.
Consult physician.

Generic Name Only in conjunction Adult : IV/IM 1 Get emergency Ototoxicity; Hypersensitivit • Observe injection
CAPREOMYCIN with other appropriate g/day for 2-4 mth, medical help if hypokalaemia y to sites for signs of
antitubercular drugs in then 2 or 3 you have any of , capreomycin excessive bleeding
treatment of pulmonary times/wk for the these signs of an hypocalcaemi and other and inflammation.
Brand Name tuberculosis when remainder of the allergic a, aminoglycosid • Lab tests:
CAPASTAT bactericidal agents, e.g., therapy. Max: 20 reaction: hives, hypomagnesa es. Perform the
isoniazid and rifampin, mg/kg/day. itching, rash; emia and an Pregnancy following as
cannot be tolerated or Dosage Details fever; difficult electrolyte (category C), guidelines for
when causative Parenteral breathing; disturbance in lactation. therapy before
organism has become Tuberculosis swelling of your resembling Safe use in drug is started and
resistant. Adult: 1 g daily, by face, lips, Bartter's infants and at regular intervals
deep IM inj or IV tongue, or syndrome; children not during therapy:
infusion, for 2-4 throat. leukocytosis, established. appropriate
mth, then 2-3 times leucopenia, bacterial
wkly for the eosinophilia; sensitivity tests;
remainder of the hypersensitivi CBC; SMA-12
therapy. Max: 20 ty reactions screening weekly;
mg/kg/day. (e.g. urticaria, weekly renal
Child: 15-30 mg/kg photosensitivi function studies
daily. Max: 1 ty, (BUN, NPN,
g/day. maculopapula creatinine
Renal Impairment r rash) clearance,
Dose reduction associated w/ sediment); liver
needed based on fever; function tests
CrCl. abnormal (periodically);
RESPIRATORY DRUGS
LFT results; serum potassium

partial levels (monthly).
neuromuscula • Reduce dosage of
r blockade; capreomycin in
pain, patients with
induration, impaired renal
excessive function, as it is
bleeding and cumulative. Follow
sterile abscess renal function tests
on inj site. closely.
Potentially • Monitor I&O
Fatal: Nephro rates and pattern:
toxicity, Report
neuromuscula immediately any
r blockade or change in output or
resp I&O ratio, any
paralysis. unusual
appearance of
urine, or elevation
of BUN above 30
mg/dL. (Normal
BUN: 10–20
mg/dL.)
• Evaluate hearing
and balance by
audiometric
measurements
(twice weekly or
weekly) and tests
of vestibular
function
(periodically).

Generic Name Serious infections Adults and Common side CNS: • • Baseline tests:
RESPIRATORY DRUGS
AMIKACIN caused by sensitive children: 15 effects of neuromuscula Contraindicate Before initial dose,
strains of Pseudomonas mg/kg/day I.M. or Amikacin r blockade. d in patients C&S; renal
aeruginosa, Escherichia I.V. infusion, in Sulfate include: EENT: hypersensitive function and
Brand Name coli, Proteus, divided doses diarrhea, ototoxicity. to drug or other vestibulocochlear
AMICARE, Klebsiella, or every 8 to 12 hours hearing loss, GU: aminoglycosid nerve function
AMIKACIN, Staphylococcus for 7 to 10 days. spinning azotemia, es. • Use (and at regular
AMIKACIDE, Uncomplicated UTI Neonates: Initially, sensation nephrotoxicit cautiously in intervals during
CINMIK caused by organisms loading dose of 10 (vertigo), y, increase in patients with therapy; closely
not susceptible to less mg/kg I.V.; then numbness, urinary impaired renal monitor in the
toxic drugs. Active 7.5 mg/kg every 12 skin tingling, excretion of function or older adult,
tuberculosis, with other hours for 7 to 10 muscle twitchin casts. neuromuscular patients with
antituberculotics days. g and Musculoskele disorders, in documented ear
Adults: 250 mg convulsions, tal: arthralgia. neonates and problems, renal
I.M. or I.V. b.i.d. dizziness, Respiratory: infants, and in impairment, or
Adults and children ringing or apnea. elderly during high dose
age 15 and older: roaring in the patients. or prolonged
15 mg/kg (up to 1 ears, • Overdose therapy).
g) I.M. or I.V. once allergic S&S: • Monitor peak and
daily five to seven reactions, Nephrotoxicity trough amikacin
times per week for Clostridium , ototoxicity, blood levels: Draw
2 to 4 months or difficile associat neurotoxicity blood 1 h after IM
until culture ed diarrhea or immediately
conversion. Then (CDAD), after completion of
reduce dose to 15 skin rash, IV infusion; draw
mg/kg daily given drug fever, trough levels
two or three times headache, immediately
weekly depending numbness and before the next IM
on other drugs in tingling, or IV dose.
regimen. Patients tremor, • Lab tests:
older than age 59 nausea, Periodic serum
may receive a vomiting, creatinine and
reduced dose of 10 increase in white BUN, complete
mg/kg (up to 750 blood cells urinalysis. With
mg) daily. Children (eosinophilia), treatment over 10
younger than age joint pain, d, daily tests of
15: Give 15 to 30 anemia, renal function,
RESPIRATORY DRUGS
mg/kg (up to 1 g) low blood weekly

I.M. or I.V. once pressure, and audiograms, and
daily or twice low blood vestibular tests are
weekly magnesium. strongly advised.
• Monitor serum
creatinine or
creatinine
clearance
(generally
preferred) more
often, in the
presence of
impaired renal
function, in
neonates, and in
the older adult;
note that prolonged
high trough (>8
mcg/mL) or peak
(>30–35 mcg/mL)
levels are
associated with
toxicity.
• Monitor S&S of
ototoxicity
[primarily involves
the cochlear
(auditory) branch;
high-frequency
deafness usually
appears first and
can be detected
only by
audiometer];
indicators of
declining renal
RESPIRATORY DRUGS
function;
respiratory tract
infections and
other symptoms
indicative of
superinfections
and notify
physician should
they occur.
• Monitor for and
report auditory
symptoms
(tinnitus, roaring
noises, sensation
of fullness in ears,
hearing loss) and
vestibular
disturbances
(dizziness or
vertigo,
nystagmus, ataxia).
• Monitor & report
any changes in
I&O, oliguria,
hematuria, or
cloudy urine.
Keeping patient
well hydrated
reduces risk of
nephrotoxicity;
consult physician
regarding optimum
fluid intake.

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

Generic Name Susceptible active Adults and Common side Lymphopenia Contraindicate • Lab tests:
RIFAPENTINE pulmonary tuberculosis. Children: effects: stomach , d in patients Sputum smear and
Latent tuberculosis Take with food. If upset, nausea, neutropenia, with a history culture, CBC,
RESPIRATORY DRUGS
infection in patients unable to swallow vomiting, loss of anemia, of baseline liver

Brand Name ≥2yrs old at high risk of tabs: may crush appetite, increased hypersensitivit functions
PRIFTIN progression to and add to semi- stomach pain, ALT, y to (especially serum
tuberculosis disease. solid food. Active diarrhea, joint arthralgia, rifamycins. transaminases) to
TB: <12yrs: not pain, skin conjunctivitis, rule out preexisting
established. rash or itching, pruritus, hepatic disease and
≥12yrs: Initial or anorexia, serum creatinine
phase: 600mg red, orange, or lymphadenop and BUN.
twice weekly for 2 brown athy, • Monitor carefully
months, with an discoloration of for S&S of toxicity
interval of no less your skin, with concurrent
than 3 consecutive tears, sweat, sali use of oral
days (72hrs) va, urine, or anticoagulants,
between doses, in stools. digitalis
combination with preparations, or
other anticonvulsants.
antituberculosis • Follow strict
drugs (eg, adherence to the
isoniazid, prescribed dosing
ethambutol, schedule to prevent
pyrazinamide); emergence of
Continuation resistant strains of
phase: Following tuberculosis.
Initial phase, • Be aware that
600mg once food may be useful
weekly for 4 in preventing GI
months in upset.
combination with Report
isoniazid or an immediately any of
appropriate the following to
antituberculosis the physician:
agent. Latent TB: fever, weakness,
<2yrs: not nausea or
established. Give vomiting, loss of
once weekly in appetite, dark urine
combination with or yellowing of
RESPIRATORY DRUGS
isoniazid (see full eyes or skin, pain

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

Generic Name Pyrazinamide is Adults and Common side Hepatitis, Diabetes- a type • Observe and
PYRAZINAMID indicated for the initial Children: effects: nausea, liver of joint disorder supervise closely.
E treatment of active 15–30mg/kg once upset stomach, dysfunction, due to excess Patients should
tubercuIosis in adults daily; max 2g vomiting, loss of gout, GI uric acid in the receive at least one
and children when daily. Or 50– appetite, mild disturbances,a blood called other effective
Brand Name combined with other 70mg/kg twice muscle or joint rthralgia, gout antituberculosis
RIFATER antitubercu-lous agents. weekly based on pain, or fatigue. myalgia, Porphyria agent concurrently.
lean body weight. blood Alcoholism • Examine patients
dyscrasias Severe liver at regular intervals
(rare). disease and question about
possible signs of
toxicity: Liver
enlargement or
tenderness,
jaundice, fever,
anorexia, malaise,
impaired vascular
integrity
(ecchymoses,
petechiae,
RESPIRATORY DRUGS
abnormal
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.
Generic Name Treatment of latent TB Adult: Common side Peripheral Drug-induced  Monitor for
ISONAIZID infection greatly Prophylaxis: effects: neuropathy hepatitis. therapeutic
reduces the risk that TB 300mg once daily. numbness and (esp. in slow Previous effectiveness:
infection will progress Active infection: tingling in the acetylators) isoniazid- Evident within
Brand Name to acitve disease 5mg/kg daily; max extremities, elevated associated the first 2–3 wk
ISOTAMINE 300mg once daily. hepatitis (sympt serum hepatic injury. of therapy. Over
Do not interrupt oms include loss transaminases Severe adverse 90% of patients
therapy. of appetite, (SGOT; reactions to receiving
Children: nausea, vomitin SGPT), isoniazid (eg, optimal therapy
Prophylaxis: g, bilirubinemia, drug fever, have negative
10mg/kg once fatigue, malaise, bilirubinuria, chills, sputum by the
daily; max 300mg and weakness), jaundice, arthritis). sixth month.
daily. Active nausea, hepatitis Acute liver  Perform
infection: 10– vomiting, disease of any appropriate
RESPIRATORY DRUGS
20mg/kg once upset stomach, etiology susceptibility

daily; max 500mg fever, or rash. tests before
daily. Do not initiation of
interrupt therap therapy and
periodically
thereafter 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.

Generic Name Asymptomatic carriers Adult: Common side Ataxia, Hypersensitivit  Lab tests:
RIFAMPIN of Neisseria Give 1hr before or effects: upset inability to y to rifampin; Periodic liver
meningitidis to 2hrs after meals stomach, concentrate, obstructive function tests are
eliminate meningococci with water. 600mg heartburn, mental biliary disease; advised. Closely
RESPIRATORY DRUGS
Brand Name from nasopharynx. Not twice daily for 2 nausea, confusion, meningococcal monitor patients
RIFADIN for treatment of days. menstrual muscular disease; with hepatic
meningococcal Children: changes, weakness, intermittent disease.
infection. Give 1hr before or headache, pain in rifampin  Check
2hrs after meals drowsiness, extremities therapy; prothrombin
with water. <1 tired feeling, or generalized lactation time daily or as
month: 5mg/kg dizziness. numbness, necessary to
every 12hrs for 2 urticaria establish and
days. ≥1 month: edema maintain
10mg/kg every hepatotoxicit required
12hrs for 2 days; y, anticoagulant
max 600mg per hepatitis, activity when
dose. Preparation abnormal patient is also
of suspension: see LFTs, receiving an
full labeling. cholestasis anticoagulant.
 Do not interrupt
prescribed
dosage regimen.
Hepatorenal
reaction with flu-
like 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
RESPIRATORY DRUGS
permanently
stained.
 Report onset of
jaundice,
hypersensitivity
reactions, and
persistence of GI
adverse effects
to physician.

Generic Name For use in the treatment Adult: Common side Metallic taste, Hypersensitivit  Perform C&S
ETHIONAMIDE of pulmonary and Give with meals to effects: stomatitis, y to prior to start of
extrapulmonary minimize GI upset. Abdominal or anorexia, ethionamide therapy. Baseline
tuberculosis when other Initially 250mg/day stomach pain, liver and chemically liver function
Brand Name antitubercular drugs in 1–4 divided diarrhea, dysfunction, related drugs tests (AST and
TRECATOR have failed. doses; titrate to increased psychosis, [e.g., isoniazid, ALT), CBC, and
highest tolerated watering of the postural niacin kidney function
dose (see full mouth, loss of hypotension, (nicotinamide)] tests including
labeling). Usual appetite, hypoglycemia ; severe liver urinalysis and
range: 15–20mg/kg metallic taste, , damage. every 2–4 wk
daily; max 1g/day. swelling or gynecomastia Safety during during therapy.
Children: inflammation of , pregnancy  Report onset of
Give with meals to the mouth, impotence, (category D), skin rash.
minimize GI upset. weight loss acne; lactation, or in Progression to
10–20mg/kg in 2–3 optic neuritis, children and exfoliative
divided doses, or visual women of dermatitis can
15mg/kg once disturbances, childbearing occur if drug is
daily. pellagra, potential is not not promptly
thrombocytop established. discontinued.
enia.  Monitor blood
glucose &
HbA1c closely
in the diabetic
until response to
RESPIRATORY DRUGS
drug is
established.
These patients
appear to be
especially prone
to hepatotoxicity

Generic Name Adjunctive treatment Adult: Common side Dermatitis, Contraindicate  Perform
ETHAMBUTOL for pulmonary Give once daily. effects: loss of Pruritus, Joint d in patients C&S prior to and
tuberculosis. Initially 15mg/kg appetite, upset Pain, GI with periodically
per day. stomach, Upset, known optic throughout
Brand Name Retreatment: vomiting, Confusion, neuritis unless therapy.
MYAMBUTOL 25mg/kg per day, numbness and Peripheral, clinical  Perform
after 60 days tingling in the Neuritis, judgment ophthalmoscopic
decrease to hands or feet, Gout, determines that examination
15mg/kg per day. blurred vision, Reduced it may be used. prior to and at
Renal dysfunction: inability to see Visual Ethambutol is monthly
reduce dose. the colors red Acuity, Optic also intervals during
Children: and green. Neuritis contraindicated therapy. Test
<13yrs: not Sudden changes in patients who eyes separately
recommended. in vision, skin are unable to as well as
rash, itching appreciate and together.
report  Monitor I&O
visual side ratio in patients
effects or with renal
changes in impairment.
vision (i.e., Report oliguria
young pediatric or any
patients or significant
unconscious changes in ratio
patients). or in laboratory
reports of kidney
function.
Systemic
RESPIRATORY DRUGS
accumulation
with toxicity can
result from
delayed drug
excretion.
 Perform liver
and kidney
function tests,
CBC, and serum
uric acid levels
at regular
intervals
throughout
therapy.
Generic Name This medication is used Active Common side Convulsions, Contraindicate  Culture
CYCLOSERINE with Tuberculosis effects: drowsiness, d in patient and
other medications to Adults, initial: 250 Confusion, somnolence with: susceptibility
treat tuberculosis (TB). mg orally every 12 Restlessness, tremor, Epilepsy. tests should be
Brand Name In some cases, it may hours for 14 days Drowsiness, dysarthria, Depression. performed before
SEROMYCIN also be used to THEN Spinning sensati vertigo, Severe anxiety. initiation of
treat urinary tract Adults: 500 mg -1 on (vertigo), allergy rash, Psychosis. therapy and
infections (UTIs). It g/day divided Irregular elevated Severe renal periodically
works by stopping the every 12 hours for heartbeats serum insufficiency. thereafter to
growth of bacteria. 18-24 months; not (arrhythmia), transaminase Excessive detect possible
to exceed 1 g/day Folate deficienc concurrent use bacterial
Children: 10-20 y, Overactive of alcohol. resistance.
mg/kg/day reflexes, Speech Monitor plasma
orally in divided disorder, drug levels
doses up to 1 g/day Dizziness, weekly and
for 18-24 months Headache, hematologic,
Monitor blood leve Coma, renal, and
ls Liver enzymes i hepatic function
ncreased, at regular
Sleepiness, intervals.
RESPIRATORY DRUGS
Weakness,  Maintenance of
Seizure, Heart blood-drug level
failure below 30 mg/mL
considerably
reduces
incidence of
neurotoxicity.
Possibility of
neurotoxicity
increases when
dose is 500 mg
or more or when
renal clearance is
inadequate.
 Observe patient
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
RESPIRATORY DRUGS
reaction

Generic Name Susceptible bacterial Adult: Common side Tendinitis/ten Hypersensitivit  Lab tests:
LEVOFLOXACI infections including ≥18yrs (CrCl effects: nausea, don rupture, y to Do C&S test
N acute bacterial sinusitis ≥50mL/min): headache, peripheral levofloxacin prior to
(ABS), acute bacterial Regimen depends diarrhea, neuropathy, and quinolone beginning
exacerbations of on pathogen type insomnia CNS effects, antibiotics; therapy and
Brand Name chronic bronchitis (see full labeling). (trouble hypersensitivi hypokalemia, periodically.
LEVAQUIN (ABECB), nosocomial Oral soln: take on sleeping), ty reactions, tendon pain,  Withhold
or community-acquired empty stomach. IV: constipation, hepatotoxicit pregnancy therapy and
pneumonia (CAP), infuse over 60 mins dizziness y, C. difficile- (category C); report to
UTIs, acute (250mg or 500mg), associated syphilis; viral physician
pyelonephritis, chronic or over 90 mins diarrhea, infections; immediately any
bacterial prostatitis, (750mg). ABS: torsades de phototoxicity; of the following:
skin and skin structure 500mg once daily pointes, lactation. Skin rash or
infections. Inhalation for 10–14 days or dysglycemia, other signs of a
anthrax (post- 750mg once daily phototoxicity, hypersensitivity
exposure): to reduce for 5 days. aortic reaction; (CNS
incidence or ABECB: 500mg aneurysm/dis symptoms such
progression of disease once daily for 7 section. as seizures,
(see full labeling). days. Nosocomial Children: also restlessness,
Plague. For ABS, pneumonia: 750mg musculoskele confusion,
ABECB, and once daily for 7–14 tal disorders. hallucinations,
uncomplicated UTIs: days. CAP: 500mg depression; skin
reserve for those who once daily for 7–14 eruption
have no alternative days or 750mg following sun
treatment options. once daily for 5 exposure;
days. symptoms of
Uncomplicated colitis such as
skin and skin persistent
structure: 500mg diarrhea; joint
once daily for 7–10 pain,
days; complicated: inflammation, or
750mg once daily rupture of a
RESPIRATORY DRUGS
for 7–14 days. tendon;

Prostatitis: 500mg hypoglycemic
once daily for 28 reaction in
days. diabetic on an
Uncomplicated oral
UTIs: 250mg once hypoglycemic
daily for 3 days. agent.
Complicated UTIs,  Learn
acute important
pyelonephritis: indications for
250mg once daily discontinuing
for 10 days or drug and
750mg once daily immediately
for 5 days. notifying
Postexposure physician.
inhalational  Consume
anthrax: 500mg fluids liberally
once daily for 60 while taking
days (start as soon levofloxacin.
as possible after  Allow a
exposure). Plague: minimum of 2 h
500mg once daily between drug
for 10–14 days. dosage and
Renal impairment taking any of the
(CrCl <50mL/min): following:
adjust dose. Aluminum or
Children: magnesium
<6mos: not antacids, iron
established. ≥6mos: supplements,
Inhalation anthrax multivitamins
(post–exposure): with zinc, or
<30kg: use other sucralfate.
forms; 30–<50kg:  Avoid
250mg every 12hrs exposure to
for 60 days; ≥50kg: excess sunlight
500mg once daily or artificial UV
RESPIRATORY DRUGS
for 60 days. light.

Plague: <30kg: use  Avoid NS
other forms; 30– AIDs while
<50kg: 250mg taking
every 12hrs for 10– levofloxacin, if
14 days; ≥50kg: possible.
500mg once daily  Do not
for 10–14 days. breast feed while
taking this drug.
PNEUMONIA DRUGS
Generic Name External ocular Adults and More common EENT: Contraindicate • Alert:
TOBRAMYCIN infections by children: In mild to Bloody nose, blurred vision d in patients Tobramycin
susceptible bacteria moderate difficulty with with hypersensitive ophthalmic
infections, instill 1 breathing, ointment, to drug or other solution isn’t for
Brand Name or 2 drops into discoloration of burning or aminoglycosid injection.
AKTOB, affected eye every sputum, runny stinging on es. Overdose • If topical ocular
TOBREX 4 hours, or apply 1- nose, stuffy instillation, S&S: Punctate tobramycin is
RESPIRATORY DRUGS
cm strip of nose, voice conjunctival keratitis, given with

ointment every 8 to changes. erythema, erythema, systemic
12 hours. In severe increased tearing, edema, tobramycin,
infections, instill 2 lacrimation, lid itching. carefully monitor
drops into infected lid itching or NURSING levels.
eye every 60 swelling. CONSIDERA • Prolonged use
minutes until TIONS may result in
condition overgrowth of
improves; then nonsusceptible
reduce frequency. organisms,
Or, apply 1-cm including fungi.
strip of ointment • Look alike–
every 3 to 4 hours sound alike: Don’t
until condition confuse
improves; then tobramycin with
reduce frequency Trobicin or Tobrex
to b.i.d. to t.i.d. with TobraDex.
PATIENT
TEACHING

Generic Name Infections caused by Adults: 150 to 450 Clindamycin CV: Contraindicate • I.M. injection
CLINDAMYCIN sensitive staphylococci, mg P.O. every 6 may cause side thrombophleb d in patients may raise CK level
streptococci, hours; or 300 to effects. Tell itis. GI: hypersensitive in response to
pneumococci, 600 mg I.M. or I.V. your doctor if nausea, to drug or muscle irritation.
Brand Name Bacteroides, every 6, 8, or 12 any of these pseudomembr lincomycin. • Monitor renal,
CLEOCIN HCL, Fusobacterium, hours. In more symptoms are anous colitis, Clindamycin hepatic, and
DALACIN C†, Clostridium severe infections, severe or do not abdominal use may result hematopoietic
CLEOCIN perfringens, and other dosage Reactions go away: pain, in overgrowth functions during
PHOSPHATE, sensitive aerobic and may be common, nausea, diarrhea, of prolonged therapy.
CLEOCIN anaerobic organisms uncommon, life- vomiting, vomiting. nonsusceptible • Observe patient
PEDIATRIC, threatening, or unpleasant or Hematologic: organisms, for signs and
DALACIN C COMMON AND metallic taste in thrombocytop particularly symptoms of
FLAVORED LIFE- the mouth, enia, transient yeasts. Monitor superinfection.
GRANULES† THREATENING. joint pain, leukopenia, patient for sign Alert: Don’t give
RESPIRATORY DRUGS
Interaction may pain when eosinophilia. of opioid

have a rapid onset swallowing, Hepatic: superinfection. antidiarrheals to
or delayed onset. heartburn, white jaundice. Use cautiously treat drug-induced
P1: NAI Printer: patches in the Skin: in neonates and diarrhea; they may
RRD LWBK786-C mouth, thick, maculopapula patients with prolong and
LWBK786-Drug white vaginal r rash, renal or hepatic worsen this
NDH2012 & discharge. urticaria. disease, condition. Black
Disease Other: asthma, history Box Warning
LWBK786- anaphylaxis. of GI disease, Diarrhea, colitis,
Drug2012 February or significant and
16, 2011 23:41 C allergies. pseudomembranou
clindamycin s colitis have
hydrochloride 331 developed up to
may be increased several weeks
to 1,200 to 2,700 following
mg/day I.M. or I.V. cessation of drug
in two, three, or therapy.
four doses. In life- • Drug doesn’t
threatening penetrate blood-
infections, dosages brain barrier.
as high as 4,800
mg daily can be
given. Children
ages 1 month to 16
years: 20 to 40
mg/kg/day I.M. or
I.V. in three or four
equal doses. In
beta-hemolytic
streptococcal
infections,
treatment should
continue for at least
10 days. Neonates
younger than age 1
month: 15 to 20
RESPIRATORY DRUGS
mg/kg/day I.M. or
I.V. in three to four
equal doses.
Generic Name Serious infections Adults: 3 mg/kg Gentamicin may CNS: Contraindicate • Evaluate
GENTAMYCIN caused by sensitive daily in three cause side encephalopat d in patients patient’s hearing
strains of Pseudomonas divided doses I.M. effects. Tell hy, seizures, hypersensitive before and during
aeruginosa, Escherichia or I.V. infusion your doctor if fever, to drug or other therapy. Notify
Brand Name coli, Proteus, every 8 hours. For any of these headache, aminoglycosid prescriber if
GENTACARE Klebsiella, Serratia, or life-threatening symptoms are lethargy, es. Use patient complains
OPHTHALMIC/ Staphylococcus infections, may severe or do not confusion, cautiously in of tinnitus, vertigo,
OTIC give up to 5 mg/kg go away: dizziness, neonates, or hearing loss.
SOLUTION, daily in three or nausea, numbness, infants, elderly • Weigh patient
GENTAM, four divided doses; vomiting, peripheral patients, and and review renal
GENTAMIN, reduce dosage to 3 diarrhea, neuropathy, patients with function studies
MAXIGEN, mg/kg daily as decreased vertigo, impaired renal before therapy
MYCIN, PHIL soon as patient appetite, pain at ataxia, function or begins. Alert: Use
PHARMAWEAL improves. the injection tingling. CV: neuromuscular preservative-free
TH/ATLANTIC Children: 2 to 2.5 site, headache, hypotension. disorders. form when
GENTAMICIN, mg/kg every 8 fever and joint EENT: Overdose S&S: intrathecal route is
ROCYGEN. hours I.M. or by pain. ototoxicity, Nephrotoxicity used adjunctively
I.V. infusion. blurred , neurotoxicity, for serious CNS
Neonates older vision, ototoxicity. infections, such as
than 1 week and tinnitus. GI: meningitis and
infants: 2.5 mg/kg vomiting, ventriculitis.
every 8 hours I.M. nausea. GU: • Hemodialysis for
or by I.V. infusion. nephrotoxicit 8 hours may
Neonates younger y, possible remove up to 50%
than 1 week and increase in of drug from
preterm infants: 2.5 urinary blood.
mg/kg every 12 excretion of • Watch for signs
hours I.M. or by casts. and symptoms of
I.V. infusion Hematologic: superinfection
agranulocytos (especially of
is, upper respiratory
RESPIRATORY DRUGS
leukopenia, tract), such as

thrombocytop continued fever,
enia, anemia, chills, and
eosinophilia. increased pulse
Musculoskele rate. • Therapy
tal: muscle usually continues
twitching, for 7 to 10 days. If
myasthenia no response occurs
gravis–like in 3 to 5 days, stop
syndrome. therapy and obtain
Respiratory: new specimens for
apnea. Skin: culture and
rash, sensitivity testing.
urticaria,
pruritus,
injection site
pain. Other:
anaphylaxis
Generic Name Serious infections Adults and Common side CNS: • • Baseline tests:
AMIKACIN caused by sensitive children: 15 effects of neuromuscula Contraindicate Before initial dose,
strains of Pseudomonas mg/kg/day I.M. or Amikacin r blockade. d in patients C&S; renal
aeruginosa, Escherichia I.V. infusion, in Sulfate include: EENT: hypersensitive function and
Brand Name coli, Proteus, divided doses diarrhea, ototoxicity. to drug or other vestibulocochlear
AMICARE, Klebsiella, or every 8 to 12 hours hearing loss, GU: aminoglycosid nerve function
AMIKACIN, Staphylococcus for 7 to 10 days. spinning azotemia, es. • Use (and at regular
AMIKACIDE, Uncomplicated UTI Neonates: Initially, sensation nephrotoxicit cautiously in intervals during
CINMIK caused by organisms loading dose of 10 (vertigo), y, increase in patients with therapy; closely
not susceptible to less mg/kg I.V.; then numbness, urinary impaired renal monitor in the
toxic drugs. Active 7.5 mg/kg every 12 skin tingling, excretion of function or older adult,
tuberculosis, with other hours for 7 to 10 muscle twitchin casts. neuromuscular patients with
antituberculotics days. g and Musculoskele disorders, in documented ear
Adults: 250 mg convulsions, tal: arthralgia. neonates and problems, renal
I.M. or I.V. b.i.d. dizziness, Respiratory: infants, and in impairment, or
Adults and children ringing or apnea. elderly during high dose
RESPIRATORY DRUGS
age 15 and older: roaring in the patients. or prolonged

15 mg/kg (up to 1 ears, • Overdose therapy).
g) I.M. or I.V. once allergic S&S: • Monitor peak and
daily five to seven reactions, Nephrotoxicity trough amikacin
times per week for Clostridium , ototoxicity, blood levels: Draw
2 to 4 months or difficile associat neurotoxicity blood 1 h after IM
until culture ed diarrhea or immediately
conversion. Then (CDAD), after completion of
reduce dose to 15 skin rash, IV infusion; draw
mg/kg daily given drug fever, trough levels
two or three times headache, immediately
weekly depending numbness and before the next IM
on other drugs in tingling, or IV dose.
regimen. Patients tremor, • Lab tests:
older than age 59 nausea, Periodic serum
may receive a vomiting, creatinine and
reduced dose of 10 increase in white BUN, complete
mg/kg (up to 750 blood cells urinalysis. With
mg) daily. Children (eosinophilia), treatment over 10
younger than age joint pain, d, daily tests of
15: Give 15 to 30 anemia, renal function,
mg/kg (up to 1 g) low blood weekly
I.M. or I.V. once pressure, and audiograms, and
daily or twice low blood vestibular tests are
weekly magnesium. strongly advised.
• Monitor serum
creatinine or
creatinine
clearance
(generally
preferred) more
often, in the
presence of
impaired renal
function, in
neonates, and in
RESPIRATORY DRUGS
the older adult;

note that prolonged
high trough (>8
mcg/mL) or peak
(>30–35 mcg/mL)
levels are
associated with
toxicity.
• Monitor S&S of
ototoxicity
[primarily involves
the cochlear
(auditory) branch;
high-frequency
deafness usually
appears first and
can be detected
only by
audiometer];
indicators of
declining renal
function;
respiratory tract
infections and
other symptoms
indicative of
superinfections
and notify
physician should
they occur.
• Monitor for and
report auditory
symptoms
(tinnitus, roaring
noises, sensation
of fullness in ears,
RESPIRATORY DRUGS
hearing loss) and

vestibular
disturbances
(dizziness or
vertigo,
nystagmus, ataxia).
• Monitor & report
any changes in
I&O, oliguria,
hematuria, or
cloudy urine.
Keeping patient
well hydrated
reduces risk of
nephrotoxicity;
consult physician
regarding optimum
fluid intake.

Generic Name Mild to moderate UTI Adults and children Side Effects: CNS: fever, Contraindicate • Monitor patient
CEFEPIME caused by Escherichia age 16 and older: Abdominal headache. d in patients for superinfection.
coli, Klebsiella 0.5 to 1 g I.M. or or stomach CV: phlebitis. hypersensitive Drug may cause
pneumoniae, or Proteus I.V. over 30 cramps, back, GI: diarrhea, to drug, overgrowth of
Brand Name mirabilis, including minutes every 12 leg, or stomach nausea, cephalosporins, nonsusceptible
MAXIPIME concurrent bacteremia hours for 7 to 10 pains, bleeding vomiting. beta-lactam bacteria or fungi.
with these days. Use I.M. only gums, Skin: rash, antibiotics, or • Drug may reduce
microorganisms. Severe for E. coli infection nosebleeds, pruritus. penicillins. Use PT activity.
UTI, including when I.M. route is convulsions, Other: cautiously in Patients at risk
pyelonephritis, caused considered more fever, chills, anaphylaxis, patients include those with
by E. coli or K. appropriate route general pain, hypersensitive renal or hepatic
pneumoniae. Moderate of administration. body swelling, inflammation, to penicillin impairment or poor
to severe pneumonia Adults and children irregular hypersensitivi because of nutrition and those
caused by age 16 and older: 2 heartbeats, ty reactions. possibility of Reactions may be
Streptococcus g I.V. over 30 mood or mental cross- common,
RESPIRATORY DRUGS
pneumoniae, minutes every 12 changes. sensitivity with uncommon, life-

Pseudomonas hours for 10 days. other beta- threatening, or
aeruginosa, K. Adults and children lactam those receiving
pneumoniae, or age 16 and older: 1 antibiotics. Use prolonged therapy.
Enterobacter species. to 2 g I.V. over 30 cautiously in Monitor PT and
Moderate to severe skin minutes every 12 breast-feeding INR in these
infection, hours for 10 days. women and in patients. Give
uncomplicated skin Adults and children patients with vitamin K, as
infection, and age 16 and older: 2 history of indicated.
skinstructure infection g I.V. over 30 colitis or renal • Look alike–
caused by minutes every 12 insufficiency. sound alike: Don’t
Streptococcus pyogenes hours for 10 days. Overdose S&S: confuse drug with
or methicillin- Adults and children Encephalopath other
susceptible strains of age 16 and older: 2 y, myoclonus, cephalosporins that
Staphylococcus aureus. g I.V. over 30 seizures, sound alike.
Complicated intra- minutes every 12 neuromuscular
abdominal infection hours for 7 to 10 excitability.
caused by E. coli, days. Give with NURSING
viridans group metronidazole.
streptococci, P.
aeruginosa, K.
pneumoniae,
Enterobacter species, or
Bacteroides fragilis
Generic Name Complicated skin and Adults and children Side effects of CNS: Contraindicate • In patients with
MEROPENEM skin-structure infections who weigh more Merrem include seizures, d in patients CNS disorders,
from Staphylococcus than 50 kg (110 nausea, headache. hypersensitive bacterial
aureus (beta-lactamase lb): 500 mg I.V. vomiting, diarrh CV: phlebitis, to components meningitis, and
Brand Name or non-beta-lactamase– every 8 hours over ea, constipation, thrombophleb of drug or compromised renal
MERREM IV producing, methicillin- 15 to 30 minutes as headache, itis. GI: other drugs in function, drug may
susceptible isolates I.V. infusion. or soreness, redn pseudomembr same class and cause seizures and
only), Streptococcus Children ages 3 ess, or swelling anous colitis, in patients who other CNS adverse
pyogenes, S. agalactiae, months and older at the injection constipation, have had reactions.
viridans group who weigh 50 kg site. diarrhea, anaphylactic • If seizures occur
RESPIRATORY DRUGS
streptococci, or less: 10 mg/kg glossitis, reactions to during therapy,

Enterococcus faecalis I.V. every 8 hours nausea, beta-lactams. stop infusion and
(excluding over 15 to 30 vomiting. Use cautiously notify prescriber.
vancomycin-resistant minutes as I.V. GU: RBCs in in elderly Dosage adjustment
isolates), Pseudomonas infusion or over 3 urine. patients and in may be needed.
aeruginosa, Escherichia to 5 minutes as I.V. Respiratory: those with a • Monitor patient
coli, Proteus mirabilis, bolus injection (5 apnea, history of for signs and
Bacteroides fragilis, to 20 ml); dyspnea, seizure symptoms of
and Peptostreptococcus maximum dose is pneumonia. disorders or superinfection.
species Complicated 500 mg I.V. every Skin: impaired renal Drug may cause
appendicitis and 8 hours. Adults injection site function. overgrowth of
peritonitis from and children who inflammation, Safety and nonsusceptible
viridans group weigh more than pruritus, rash. effectiveness bacteria or fungi.
streptococci, E. coli, 50 kg: 1 g I.V. Other: of drug haven’t • Periodic
Klebsiella pneumoniae, every 8 hours over anaphylaxis, been assessment of
Pseudomonas 15 to 30 minutes as sepsis, established for organ system
aeruginosa, B. fragilis, I.V. infusion or hypersensitivi infants younger functions,
B. thetaiotaomicron, over 3 to 5 minutes ty reactions, than age 3 including renal,
and Peptostreptococcus as I.V. bolus inflammation. months. Use hepatic, and
species. Bacterial injection (5 to 20 drug cautiously hematopoietic
meningitis from S. ml). Children ages in breast- function, is
pneumoniae, 3 months and feeding recommended
Haemophilus older, who weigh women; it’s during prolonged
influenzae, and 50 kg or less: 20 unknown if therapy.
Neisseria meningitidis. mg/kg I.V. every 8 drug appears in • Monitor patient’s
Community-acquired hours over 15 to 30 breast milk. fluid balance and
pneumonia. Hospital- minutes as I.V. weight carefully.
acquired pneumonia infusion or over 3
(uncomplicated) to 5 minutes as I.V.
bolus injection (5
to 20 ml);
maximum dose is 1
g I.V. every 8
hours . Children
who weigh more
than 50 kg: 2 g I.V.
RESPIRATORY DRUGS
every 8 hours.
Children ages 3
months and older,
who weigh 50 kg
or less: 40 mg/kg
I.V. every 8 hours;
maximum dose, 2 g
I.V. every 8 hours.
Adults: 500 mg
I.V. every 8 hours
for at least 5 days
in combination
with a
fluoroquinolone.
Adults: 1 g I.V.
every 8 hours for 7
to 8 days.
Generic Name Treatment of moderate Moderate to Severe Common side CNS: Headac Hypersensitivit • Obtain history of
PIPERACILLIN/ to severe appendicitis, Infections effects of Zosyn he, insomnia, y to hypersensitivity to
TAZOBACTAM uncomplicated and Adult: IV 3.375 g include: fever. GI: Dia piperacillin, penicillins,
complicated skin and q6h, infused over injection site rrhea, tazobactam, cephalosporins, or
Brand Name skin structure 30 min, for 7–10 d reactions like. constipation, penicillins, other drugs prior to
ZOSYN infections, endometritis, Child: IV <6 swelling, nausea, cephalosporins, administration.
pelvic inflammatory mo, 150–300 mg redness, pain, vomiting, or beta- • Lab tests: C&S
disease, or nosocomial piperacillin/kg/d soreness or. dyspepsia, ps lactamase prior to first dose
or community-acquired divided q6–8h; 6 Irritation, eudomembra inhibitors such of the drug; start
pneumonia caused by mo, 240 mg agitation, nous as clavulanic drug pending
piperacillin-resistant, piperacillin trouble sleeping colitis. Skin: acid and results. Monitor
piperacillin/tazobactam- component/kg/d (insomnia), Rash, sulbactam. hematologic status
susceptible, beta- divided q8h vomiting, pruritus, with prolonged
lactamase-producing Nosocomial stomach pain or hypersensitivi therapy (Hct and
bacteria. Pneumonia upset, diarrhea, ty reactions. Hgb, CBC with
Adult: IV 4.5 g constipation, differential and
q6h, infused over runny nose, platelet count).
RESPIRATORY DRUGS
30 min, for 7–10 d • Monitor patient

Renal Insufficiency carefully during
Clcr 20–40 the first 30 min
mL/min: 2.25 g after initiation of
q6h; <20 mL/min: the infusion for
2.25 g q8h signs of
hypersensitivity

Generic Name To treat infections of Moderate to Severe Common side Body as a Hypersensitivit • Determine
CEFTAZIDIME lower respiratory tract, Infections effects: injection Whole: Fever y to history of
skin and skin structures, Adult: IV/IM 1–2 g site reactions , phlebitis, cephalosporins hypersensitivity to
urinary tract, bones and q8–12h, up to 2 g (swelling, pain or and related cephalosporins and
Brand Name joints; also used to treat q6h redness, pain, inflammation beta-lactam penicillins, and
FORTAZ, TAZI bacteremia, Geriatric: IV/IM 1– or soreness), at injection antibiotics; other drug
CE, TAZIDIME gynecological, intra- 2 g q12h nausea, site, pregnancy allergies, before
abdominal and CNS Child: IV/IM <4 vomiting, superinfectio (category B). therapy begins.
infections (including wk, 30 mg/kg diarrhea, ns. GI: Nause • Lab tests:
meningitis). q12h; 1 mo–12 y, stomach a, Perform culture
30–50 mg/kg/d in 3 or abdominal vomiting, diar and sensitivity
divided doses pain, rhea, abdomi studies before
(max: 6 g/d) headache, nal pain, initiation of
dizziness, metallic taste, therapy and during
numbness or drug- therapy as
tingly feeling associated pse indicated. Therapy
udomembran may begin pending
ous test results.
colitis. Skin: • If administered
Pruritus, rash, concomitantly with
urticaria. Uro another antibiotic,
genital: Vagin monitor renal
itis, function and report
candidiasis. if symptoms of
dysfunction appear
(e.g., changes in
RESPIRATORY DRUGS
I&O ratio and

pattern, dysuria).
• Be alert to onset
of rash, itching,
and dyspnea.
Check patient's
temperature. If it is
elevated, suspect
onset of
hypersensitivity
reaction (see
Appendix F).
• Monitor for
superinfection.
(See Appendix F.
• If diarrhea occurs
and is severe,
suspect
pseudomembranou
s colitis (caused
by Clostridium
difficile). Check
temperature:
Report fever and
severe diarrhea to
physician; drug
should be
discontinued.
Generic Name Infections of GU, Systemic Infections Common Side Body as a Hypersensitivit • Determine
AMPICILLIN respiratory, and GI Adult: PO 250–500 effects of Whole: Simil y to penicillin previous
tracts and skin and soft mg q6h IV/IM 250 Ampicillin ar to those for derivatives; hypersensitivity
tissues; also gonococcal mg–2 g q6h include: acute penicillin G. infectious reactions to
Brand Name infections, bacterial Child: PO 25–50 inflammatory Hypersensitiv mononucleosis. penicillins,
AMCILL, meningitis, otitis media, mg/kg/d divided skin eruption ity (pruritus, cephalosporins,
RESPIRATORY DRUGS
AMPICIN sinusitis, and q6h IV/IM 25–100 (erythema urticaria, and other allergens

septicemia and for mg/kg/d divided multiforme), eosinophilia, prior to therapy.
prophylaxis of bacterial q6h redness and hemolytic • Lab tests:
endocarditis. Used Neonate: IV/IM 7 peeling of the anemia, Baseline C&S tests
parenterally only for d & 2000 g, 50 skin (exfoliative interstitial prior to initiation
moderately severe to mg/kg/d divided dermatitis), rash, nephritis, ana of therapy; start
severe infections. q12h; 7 d & hives, fever, phylactoid drug pending
>2000 g, 75 seizure, black reaction); results. Baseline
mg/kg/d divided hairy tongue, superinfectio and periodic
q8h; >7 d, 50–100 diarrhea. ns. CNS: Con assessments of
mg/kg/d divided vulsive renal, hepatic, and
q6–12h seizures with hematologic
high functions,
Meningitis doses. GI: Di particularly during
Adult/Child: IV 15 arrhea, nause prolonged or high-
0–200 mg/kg/d a, dose therapy.
divided q4–6h vomiting, pse • Note: Sodium
Neonate: IV/IM 7 udomembran content of drug
d & 2000 g, 100 ous must be considered
mg/kg/d divided colitis. Other: in patients on
q12h; 7 d & Severe pain sodium restriction.
>2000 g, 150 (following • Inspect skin daily
mg/kg/d divided IM); phlebitis and instruct patient
q8h; >7 d, 100–200 (following to do the same.
mg/kg/d divided IV). Skin: Ra The appearance of
q6–12h sh. a rash should be
carefully evaluated
Gonorrhea to differentiate a
Adult: PO 3.5 g nonallergenic
with 1 g ampicillin rash
probenecid times from a
1 IV/IM 500 mg hypersensitivity
q8–12h reaction. Report
rash promptly to
physician.
• Note: Incidence
RESPIRATORY DRUGS
of ampicillin rash
is higher in
patients with
infectious
mononucleosis or
other viral
infections, Salmon
ella infections,
lymphocytic
leukemia, or
hyperuricemia or
in patients taking
allopurinol.
• Take medication
around the clock;
continue taking
medication until it
is all gone (usually
10 d) unless
otherwise directed
by physician or
pharmacist.
Generic Name Treatment of infections Systemic Infections Common side Body as a Hypersensitivit • Determine
SULBACTAM due to susceptible Adult/Child: IV/IM effects may Whole: Hyper y to previous
(+AMPICILLIN) organisms in skin and 40 kg, 1.5 (1 g include: sensitivity penicillins; hypersensitivity
skin structures, ampicillin, 0.5 g swollen, black, (rash, mononucleosis. reactions to
intraabdominal sulbactam) to 3 g or "hairy" itching, anaph penicillins,
Brand Name infections, and (2 g ampicillin, 1 g tongue; mild or ylactoid cephalosporins,
UNASYN gynecologic infections. sulbactam) q6h occasional diarr reaction), and other allergens
(max: 4 g hea; fatigue, prior to therapy.
sulbactam/d) vaginal itching o malaise, • Lab tests:
Child: IV 1 y, 300 r discharge; headache, Baseline C&S tests
mg/kg/d (200 mild skin rash; chills, prior to initiation
mg/kg ampicillin or edema. GI: Di of therapy; start
RESPIRATORY DRUGS
and 100 mg/kg pain, swelling, b arrhea, drug pending

sulbactam) divided ruising, or nausea, vomit results.
q6h irritation around ing, • Report promptly
the IV needle. abdominal unexplained
distention, bleeding (e.g.,
candidiasis. H epistaxis, purpura,
ematologic: N ecchymoses).
eutropenia,
thrombocytop
enia. Urogeni
tal: Dysuria.
CNS: Seizure
s. Other: Loca
l pain at
injection site;
thrombophleb
itis.
Generic Name Infections caused by Moderate to Severe Nausea, vomitin Body as a Hypersensitivit • Determine
CEFUROXIME susceptible organisms Infections g, diarrhea, Whole: Thro y to history of
in the lower respiratory Adult: PO 250–500 strange taste in mbophlebitis cephalosporins hypersensitivity
tract, urinary tract, skin, mg the mouth, or (IV site); and related reactions to
Brand Name and skin structures; also q12h IV/IM 750 stomach pain pain, burning, antibiotics; cephalosporins,
CEFTIN, used for treatment of mg–1.5 g q6–8h may occur. cellulitis (IM pregnancy penicillins, and
ZINACEF, meningitis, gonorrhea, Child (3 mo–12 Diaper rash may site); (category B), history of allergies,
KEFUROX and otitis media and for y) : PO 10–15 occur in young superinfectio lactation. particularly to
perioperative mg/kg (125–250 children. ns, positive drugs, before
prophylaxis (e.g., open- mg) Dizziness and Coombs' therapy is initiated.
heart surgery), early q12h IV/IM 75– drowsiness may test. GI: Diarr • Lab tests:
Lyme disease. 100 mg/kg/d occur less hea, nausea, Perform culture
divided q8h (max: frequently, antibiotic- and sensitivity
6 g/d) especially with associated tests before
Neonate: IM/IV 20 higher doses. colitis. Skin: initiation of
–100 mg/kg/d Rash, therapy and
divided q12h pruritus, periodically during
RESPIRATORY DRUGS
Bacterial urticaria. Uro therapy if

Meningitis genital: Incre indicated. Therapy
Adult: IV/IM 3 g ased serum may be instituted
q8h creatinine and pending test
Child: IV/IM 200– BUN, results. Monitor
240 mg/kg/d decreased periodically BUN
divided q6–8h; creatinine and creatinine
reduced to 100 clearance. clearance.
mg/kg/d upon • Inspect IM and
improvement IV injection sites
Surgical frequently for
Prophylaxis signs of phlebitis.
Adult: IV/IM 1.5 g • Report onset of
30–60 min before loose stools or
surgery, then 750 diarrhea. Although
mg q8h for 24 h pseudomembranou
Child: IV/IM Same s colitis (see Signs
as for adult & Symptoms,
Appendix F) rarely
occurs, this
potentially life-
threatening
complication
should be ruled out
as the cause of
diarrhea during
and after antibiotic
therapy.
• Monitor for
manifestations of
hypersensitivity
(see Appendix F).
Discontinue drug
and report their
appearance
promptly.
RESPIRATORY DRUGS
• Monitor I&O
rates and pattern:
Especially
important in
severely ill patients
receiving high
doses. Report any
significant
changes.
Generic Name Infections caused by Mild to Moderate The most GI: Diarrhea, Combination • Determine
CO- susceptible beta- Infections common side nausea, shares toxic previous
AMOXICLAV lactamase-producing Adult: PO 250 or effects of co- vomiting. Ski potential of hypersensitivity
organisms: lower 500 mg tablet (each amoxiclav n: Rash, ampicillin. reactions to
respiratory tract with 125 mg are diarrhoea, th urticaria. Oth Hypersensitivit penicillins,
Brand Name infections, acute clavulanic acid) rush and feeling er: Candidal y to penicillins; cephalosporins,
AUGMENTIN bacterial sinusitis, q8–12h; Sustained- or being sick. vaginitis; infectious and other allergens
community acquired release tabs: 2 Co-amoxiclav moderate mononucleosis. prior to therapy.
pneumonia, otitis tablets (2000 mg liquid can stain increases in • Lab tests:
media, sinusitis, skin amoxicillin/125 mg teeth. This is not serum ALT, Baseline C&S tests
and skin structure clavulanate) permanent and AST; prior to initiation
infections, and UTI. q12h x 7–10 d brushing your glomerulonep of therapy; start
Child: PO <40 teeth will hritis; agranul drug pending
kg, 20–40 mg/kg/d remove any ocytosis (rare results.
(based on stains. ). • Monitor for S&S
amoxicillin of an urticarial
component) rash (usually
divided q8–12h; >3 occurring within a
mo, 90 mg/kg/d of few days after start
600 ES divided of drug) suggestive
q12h x 10 d of a
Neonate/Infant: PO hypersensitivity
<3 mo, 30 mg/kg/d reaction. If it
(amoxicillin) occurs, look for
divided q12h other signs of
RESPIRATORY DRUGS
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.
Generic Name Roxithromycin, like 150 mg twice daily Most common Gastrointestin Hypersensitivit • Monitor for the
ROXITHROMY erythromycin, is used in or 300 mg once side effects are al y to severe dizziness, if
CIN the treatment of a wide daily before meals gastrointestinal; disturbances hepatic affected, do not
variety of infections or as prescribed the diarrhea, nausea, are the most impairment. drive or operate
caused by susceptible physician. abdominal pain frequent Concomitant machinery.
Brand Name organisms. Its uses and vomiting. adverse use with • Monitor, ECG,
ROXIMED have included Less common effect, but are vasoconstrictiv LFT, kidney
bronchitis, severe side effects less frequent e ergot functions and
campylobacter enteritis, include central than alkaloids and blood counts.
chancroid, diphtheria, or peripheral erythromycin. drugs which • Special
legionnaire's disease nervous system Increases in delay peritalsis precaution with
and other Legionella events such liver enzyme congenital
RESPIRATORY DRUGS
infections, neonatal as headaches, values and prolongation of QT

conjunctivitis, pertussis, dizziness, hepatitis have interval or other
pneumonia (as well as vertigo, and also been cardiac diseases:
streptococcal), sinusitis the rarely seen reported. myasthenia gravis.
and combined with rashes, abnormal Rashes, Renal and hepatic
neomycin, for the liver function headache, impairment.
prophylaxis of surgical values and dizziness, Elderly and
infection in patients alteration in weakness and Preganancyand
undergoing bowel senses of smell changes in lactation.
surgery. and taste. blood cell
counts have
also occurred.
Generic Name Fixed combination of Systemic Infections If you Skin: Mild to Hypersensitivit • Be aware that IV
TRIMETHOPRIM- sulfamethoxazole Adult: PO 160 mg experience any moderate y to TMP, SMZ, Septra contains
SULFAMETHOXAZ (SMZ), an intermediate TMP/800 mg SMZ of the rashes sulfonamides, sodium
OLE (TMP-SMZ) acting antiinfective [1 double strength following sympt (including or bisulfites; metabisulfite,
sulfonamide, and (DS) tablet] oms, call your fixed drug group A beta- which produces
Brand Name trimethoprim (TMP), a q12h IV 8–10 doctor eruptions), to hemolytic allergic-type
BACTRIM, CO- synthetic antiinfective. mg/kg/d TMP immediately: xic epidermal streptococcal reactions in
TRIMOXAZOLE, SE Both components of divided q6–12h rash, itching, necrolysis. GI: pharyngitis; susceptible
PTRA the combination are infused over 60–90 sore throat, Nausea, megaloblastic patients: Hives,
synthetic folate min fever or chills, vomiting, diar anemia due to itching, wheezing,
antagonist Child: PO >2 mo & severe diarrhea rhea, anorexi folate anaphylaxis.
antiinfectives. <40 kg, 4 mg/kg/d (watery or a, hepatitis, p deficiency; Susceptibility (low
Mechanism of action is TMP q12h; >40 bloody stools) seudomembr creatinine in general
principally enzyme kg, 160 mg that may occur anous clearance <15 population) is seen
inhibition, which TMP/800 mg SMZ with or without enterocolitis, mL/min; most frequently in
prevents bacterial (1 DS tablet) fever and stomatitis, pregnancy asthmatics or
synthesis of essential q12h IV >2 mo, 8– stomach cramps glossitis, (category C), atopic
nucleic acids and 10 mg/kg/d TMP (may occur up abdominal lactation. Not nonasthmatic
proteins. divided q6–12h to 2 months or pain. Urogeni recommended persons.
infused over 60–90 more after your tal: Kidney for infants <2 • Lab tests:
min treatment), failure, mo. Baseline and
RESPIRATORY DRUGS
shortness of oliguria, followup

Pneumocystis breath and anuria, urinalysis; CBC
carinii Pneumonia cough. crystalluria. H with differential,
Adult: IV 20 ematologic: A platelet count,
mg/kg/d TMP granulocytosi BUN and
divided q6h s (rare), aplas creatinine
infused over 60–90 tic clearance with
min anemia (rare) prolonged
, therapy.
Prophylaxis megaloblastic • Monitor
for Pneumocystis anemia, coagulation tests
carinii Pneumonia hypoprothro and prothrombin
Adult: PO 160 mg mbinemia, times in patient
TMP/800 mg SMZ thrombocyto also receiving
q24h penia warfarin. Change
Child: PO 150 (rare). Body in warfarin dosage
mg/m2 TMP/750 as a may be indicated.
mg/m2 SMZ b.i.d. Whole: Weak • Monitor I&O
3 consecutive d/wk ness, volume and
(max: 320 mg arthralgia, pattern. Report
TMP/d) myalgia, significant changes
photosensitiv to forestall renal
Renal Impairment ity, allergic calculi formation.
Clcr 10–30 mL/min: myocarditis. Also report failure
reduce dose by of treatment (i.e.,
50%; <10 mL/min: continued UTI
reduce dose by symptoms).
75%. For all • Older adult
indication patients are at risk
for severe adverse
reactions,
especially if liver
or kidney function
is compromised or
RESPIRATORY DRUGS
if certain other
drugs are given.
Most frequently
observed:
Thrombocytopenia
(with concurrent
thiazide diuretics);
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.

Generic Name This medication is a Administered Common signs: Fever, chills, Contraindicate • Lab tests: Obtain
SULFISOXAZO sulfonamide orally (tablets) dizziness, arthralgia, d in patient a specimen for
LE antibacterial, prescribed Adults: headache, malaise, with: C&S prior to
for treating and Loading dose: 2-4 lethargy, allergic History of initiation of
RESPIRATORY DRUGS
preventing certain grams diarrhea, myocarditis, hypersensitivit therapy. Perform

Brand Name bacterial infections. It Maintenance dose: anorexia, serum y to frequent kidney
SULFAFURAZO helps keep bacteria 4-8 grams per day nausea, sickness, sulfonamides, function tests and
LE from growing in the in 4-6 divided vomiting, and anaphylactoid salicylates, or urinalyses;
body. doses serious reactions, chemically complete blood
Children (>2 skin rashes. lymphadenop related drugs; counts and liver
months): athy local Use in function tests,
Initial dose: reaction treatment of especially during
75mg/kg following IM group A beta- regimens longer
Maintenance dose: injection, hemolytic than 2 wk.
150mg/kg/day in 4- fixed drug streptococcal • Monitor I&O.
6 divided doses eruptions, infections; Report oliguria and
(maximum of 6 diuresis, Infants <2 mo changes in I&O
grams per day) overgrowth of of age (except ratio. Fluid intake
nonsusceptibl in treatment of should be adequate
e organisms, congenital to support urinary
LE toxoplasmosis) output of at least
phenomenon. ; porphyria; 1500 mL/d to
Advanced prevent crystalluria
kidney or liver and stone
disease; formation.
intestinal and Check urine pH
urinary daily with
obstruction; Nitrazine paper or
Pregnancy Labstix; fall in
(category B, urinary pH (more
category D if acidic) increases
near term), risk of crystalluria.
lactation • Report increasing
urine acidity. If
urine is highly
acidic, physician
may prescribe a
urinary alkalinizer.
• Monitor
temperature.
RESPIRATORY DRUGS
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,
jaundice).
• Be alert for skin
lesions, papular or
vesiculobullous
RESPIRATORY DRUGS
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.

Generic Name Indicated in adults for Oropharyngeal Can Common side Nausea, Contraindicate • Monitor for
FLUCONAZOLE the prophylaxis of: didiasis effects: headache, d in patient allergic response.
Relapse of cryptococcal Adult: 200 mg headache, rash, with: Patients allergic to
meningitis in patients orally on Day 1, diarrhea, nausea vomiting, Hypersensitivit other azole
RESPIRATORY DRUGS
Brand Name with high risk of THEN 100 mg or upset abdominal y to antifungals may be
DIFLUCAN recurrence. Relapse of once/day stomach, pain, fluconazole or allergic to
oropharyngeal or Pediatric: 6 mg/kg dizziness, diarrhea, other azole fluconazole.
oesophageal candidiasis orally on Day 1, stomach pain, dizziness; antifungals; Lab tests: Monitor
in patients infected with THEN 3 mg/kg vomiting hepatotoxicit pregnancy BUN, serum
HIV who are at high once/day; not to changes in the y, (category C), creatinine, and
risk of experiencing exceed 600 mg/day way food tastes adrenal lactation. liver function.
relapse. Esophageal Candid severe rash in insufficiency; • Note: Drug may
iasis people with rare: cause elevations of
Adult: 200 mg lowered anaphylaxis, the following
orally on Day 1, immunity exfoliative laboratory serum
THEN 100 mg dermatitis, values: ALT, AST,
once/day; doses up QT alkaline
to 400 mg/day may prolongation, phosphatase,
be used based Torsade de bilirubin.
on patient's pointes. Monitor for S&S
response of hepatotoxicity.
Pediatric: 6 mg/kg • Monitor carefully
orally on Day 1, for loss of
THEN 3 mg/kg glycemic control if
once/day diabetic.
Cryptococcal Meni Inform physician
ngitis of all medications
Adult being taken.
400 mg orally on
Day 1, 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
orally once/day
RESPIRATORY DRUGS
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/Perito
nitis 50-200 mg
orally once/day
Systemic Candida
Infections,
Pediatric
6-12 mg/kg/day
orally/intravenousl
y (IV); not to
exceed 600 mg/da

Generic Name Invasive fungal Adults and Common side Body as a Contraindicate • Notify physician
AMPHOTERICI infections in patients Children: efectsi: njection Whole: Hyper d in patients if improvement
NB who are refractory to, 5mg/kg daily as a site reactions sensitivity with: does not occur
or intolerant of, single IV infusion, (pain, swelling, (pruritus, Hypersensitivit within 1–2 wk or if
conventional at a rate of irritation), urticaria, skin y to lesions appear to
Brand Name amphotericin B therapy. 2.5mg/kg per hour. fever,shaking, rashes, fever, amphotericin. worsen. Nail
ABELCET Renal impairment: chills,flushing, dyspnea, anap infections usually
reduce dose. loss of appetite, hylaxis); feve require several
weight loss, r, chills. months or longer
RESPIRATORY DRUGS
dizziness, CNS: Headac to improve.

nausea, he, sedation, • Wash towels and
vomiting, muscle pain, clothing that were
diarrhea, arthralgia, in contact with
upset stomach, weakness. affected areas after
headache, CV: Hypoten each treatment.
shortness of sion, cardiac • Note: Topical
breath, muscle arrest. cream slightly
or joint aches, Special discolors the skin.
warmth/redness/ Senses: Ototo Generally, lotion
tingly feeling xicity with and ointment do
under your skin, tinnitus, not stain skin when
itching or rash, vertigo, loss rubbed in, but nail
or fast breathing of lesions may be
1 to 3 hours hearing. GI: n stained.
after the ausea, • Do not breast
infusion starts. vomiting, feed while taking
diarrhea, this drug without
epigastric consulting
cramps, physician.
anorexia, • Lab tests:
weight loss. Baseline C&S tests
Hematologic: prior to initiation
Anemia, of therapy; start
thrombocytop drug pending
enia. results. Baseline
Metabolic: H and periodic BUN,
ypokalemia, serum creatinine,
hypomagnese creatinine
mia. clearance; during
Urogenital: N therapy periodic
ephrotoxicity, CBC, serum
urine with electrolytes
low specific (especially K+,
gravity. Mg++, Na+, Ca+
Skin: Dry, +), and liver
RESPIRATORY DRUGS
erythema, function tests.

pruritus, • Monitor for S&S
burning of local
sensation; inflammatory
allergic reaction or
contact thrombosis at
dermatitis, injection site,
exacerbation particularly if
of lesions. extravasation
Other: Pain; occurs.
arthralgias, • Monitor
thrombophleb cardiovascular and
itis (IV site), respiratory status
superinfectio and observe patient
ns. 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
RESPIRATORY DRUGS
continued therapy.
Keep physician
informed.
• Monitor I&O and
weight. Report
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.
Generic Name Susceptible infections Adult: Common side Skin: Mild to Contraindicate • Be aware that IV
SULFAMETHO including UTIs (not for 1 DS tab, 2 regular effectsd: loss of moderate d in patients Septra contains
XAZOLE initial uncomplicated tabs, or 20mL of appetite, nausea, rashes with: sodium
episodes), shigellosis, susp every 12hrs vomiting, (including History of metabisulfite,
Brand Name prophylaxis and for 5 days painful fixed drug drug-induced which produces
BACTRIM treatment (shigellosis, or swollen eruptions), to immune allergic-type
of Pneumocystis travelers' diarrhea), tongue, xic epidermal thrombocytope reactions in
jiroveci pneumonia or 10–14 days dizziness, necrolysis. nia with use of susceptible
(PJP), travelers' (UTIs), or 14 days spinning GI: Nausea, trimethoprim patients: Hives,
RESPIRATORY DRUGS
diarrhea or acute (bronchitis). PJP sensation, vomiting, diar and/or itching, wheezing,

exacerbations of treatment: 15– ringing in your rhea, anorexia sulfonamides. anaphylaxis.
chronic bronchitis in 20mg/kg per day of ears,tiredness, or , hepatitis, ps Megaloblastic Susceptibility (low
adults, acute otitis trimethoprim (75– sleep problems eudomembra anemia due to in general
media in children. 100mg/kg per day (insomnia). nous folate population) is seen
of enterocolitis, deficiency. most frequently in
sulfamethoxazole) stomatitis, Children <2 asthmatics or
in 4 divided doses glossitis, months. atopic
at 6-hour intervals abdominal Marked hepatic nonasthmatic
for 14–21 days; pain. damage. persons.
PJP prophylaxis: Urogenital: K Severe renal • Lab tests:
one DS tab daily. idney failure, insufficiency Baseline and
Renal impairment oliguria, when renal followup
(CrCl 15– anuria, status cannot urinalysis; CBC
30mL/min): reduce crystalluria. be monitored. with differential,
dose by ½; (CrCl Hematologic: platelet count,
<15mL/min): not Agranulocyto BUN and
recommended. sis (rare), apla creatinine
Children: stic clearance with
<2 months: see anemia (rare), prolonged therapy.
Contraindications. megaloblastic • Monitor
≥2 months: 8mg/kg anemia, coagulation tests
per day hypoprothro and prothrombin
trimethoprim mbinemia, times in patient
(40mg/kg per day thrombocytop also receiving
of enia (rare). warfarin. Change
sulfamethoxazole) Body as a in warfarin dosage
in 2 divided doses Whole: Weak may be indicated.
at 12-hour intervals ness, • Monitor I&O
for 5 days arthralgia, volume and
(shigellosis) or 10 myalgia, pattern. Report
days (otitis media, photosensitivi significant changes
UTIs). PJP ty, allergic to forestall renal
treatment: as adult; myocarditis. calculi formation.
PJP prophylaxis or Also report failure
renal impairment of treatment (i.e.,
RESPIRATORY DRUGS
continued UTI
symptoms).
Older adult
patients are at risk
for severe 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);
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
RESPIRATORY DRUGS
depression.
Generic Name Indicated in patients Usual Adult Dose Common side Body as a Contraindicate • Monitor for S&S
GATIFLOXACI with: for Pneumonia: effects: mild Whole: Head d in patients of CNS
N Acute bacterial Community- nausea, ache, allergic with: disturbance
exacerbation of chronic acquired: 400 mg vomiting, reactions, Hypersensitivit especially with
bronchitis; acute orally or IV once a stomach pain, chills, fever; y to history of
Brand Name sinusitis; community- day for 7 to 14 diarrhea, back pain, gatifloxacin or cerebrovascular
ZYMAXID acquired pneumonia; days dizziness, chest pain. other disease or seizures.
uncomplicated or Adults and restlessness, CNS: Dizzine quinolone • Lab tests: C&S
complicated UTI; Children: confusion, ss, abnormal antibiotics; prior to initiation
pyelonephritis; <1yr: not vaginal, dreams, pregnancy of therapy; WBC
gonorrhea due to established. ≥1yr: 1 discharge or insomnia, (category C). with differential.
susceptible organisms. drop every 2hrs in itching paresthesia, • Monitor diabetics
affected eye(s) sleep problems tremor, for loss of
while awake (max (insomnia vasodilatation glycemic control.
8 doses) on day 1, or nightmares), , vertigo. • Monitor for
then 1 drop in or CV: Palpitati changes in digoxin
affected eye(s) 2–4 headache on; peripheral blood levels with
times daily while edema. coadministered
awake on days 2–7. GI: Nausea, drugs.
diarrhea, • Be aware that
abdominal increased risk of
pain, seizures are
constipation, associated with
dyspepsia, drug use in patient
glossitis, oral with history of
moniliasis, seizures.
stomatitis, • Report
vomiting. unexplained
Respiratory: dizziness or
Dyspnea, problems with
pharyngitis. balance, severe
Skin: Rash, diarrhea, skin rash,
sweating. mental status
RESPIRATORY DRUGS
Urogenital: V changes.
aginitis, • Do not breast
dysuria, feed while taking
hematuria. this drug without
Special consulting
Senses: Abno physician.
rmal vision,
taste
perversion,
tinnitus.
Metabolic: H
yperglycemia,
hypoglycemia
.
Other: Cartila
ge erosion.
Generic Name Susceptible infections Adult: Common side GI: Diarrhea, Combination • Determine
CLAVULANIC including community- Take with meals. effects: diarrhea, nausea, shares toxic previous
ACID acquired pneumonia May split scored upset stomach, vomiting. potential of hypersensitivity
and acute bacterial tabs; do not reduce vomiting, Skin: Rash, ampicillin. reactions to
sinusitis dose. Two mild skin rash, urticaria. Hypersensitivit penicillins,
Brand Name Augmentin 500mg severe skin rash, Other: Candid y to penicillins; cephalosporins,
AUGMENTIN tabs are not itching, al vaginitis; infectious and other allergens
XR equivalent to one hives, moderate mononucleosis. prior to therapy.
XR tab. ≥16yrs: 2 difficulty increases in • Lab tests:
tabs every 12 hrs. breathing or serum ALT, Baseline C&S tests
Sinusitis: treat for swallowing, AST; prior to initiation
10 days. CAP: treat wheezing, glomerulonep of therapy; start
for 7–10 days. vaginal itching hritis; agranul drug pending
Children: and discharge, ocytosis (rare results.
<16yrs: not yellowing of the ). • Monitor for S&S
recommended. skin or eyes. of an urticarial
rash (usually
occurring within a
RESPIRATORY DRUGS
few days after start

of drug) suggestive
of a
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.

Generic Name Susceptible infections Adult: Common side CNS: Dizzine Hypersensitivit • Monitor
MOXIFLOXACI including acute ≥18yrs: 400mg effects: ss, headache, y to therapeutic
N bacterial sinusitis once daily. ABS: nausea peripheral moxifloxacin effectiveness
(ABS), acute bacterial treat for 10 days. diarrhea neuropathy. or other indicated by
RESPIRATORY DRUGS
Brand Name exacerbations of ABECB: treat for 5 headache GI: Nausea, quinolones; clinical
AVELOX chronic bronchitis days. Pneumonia: vomiting diarrhea, moderate to improvement of
(ABECB), community treat for 7–14 days. dizziness abdominal severe hepatic infection.
acquired pneumonia, Skin and skin nervousness pain, insufficiency; • Monitor for and
skin and skin structure, structure: treat for agitation vomiting, syphilis; notify physician
complicated intra- 7 days, if nightmares taste pregnancy immediately of
abdominal infections, complicated: 7–21 perversion, (category C); adverse CNS
plague. For ABS and days. Intra- abnormal lactation; effects.
ABECB: reserve for abdominal: treat liver function patients with • Notify physician
those who have no for 5–14 days. tests, history of immediately for
alternative treatment Plague: treat for dyspepsia. prolonged S&S of
options. 10–14 days; begin Musculoskele QTC interval hypersensitivity.
as soon as possible tal: Tendon on ECG, • Lab tests: C&S
after suspected or rupture, history of before initiation of
confirmed cartilage ventricular therapy and
exposure. IV erosion. arrhythmias, baseline serum
formulation may be atrial potassium with
used if oral route fibrillation, history of
not preferable; hypokalemia, hypokalemia.
administer IV bradycardia, • Exercise care in
infusion over acute timing of
60mins, may myocardial consumption of
switch from IV to ischemia, acute vitamins and
oral route when MI, patients antacids
clinically indicated. receiving Class (see ADMINISTR
Children: IA or Class III ATION).
<18yrs: not antiarrhythmic • Drink fluids
established. drugs; tendon liberally, unless
pain; directed otherwise.
viral infection; • Increased seizure
torsade de potential is
pointes; possible, especially
ocular when history of
preparation use seizure exists.
in children <1 • Stop taking drug
y. and notify
RESPIRATORY DRUGS
physician if
experiencing
palpitations,
fainting, 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.
Generic Name Susceptible bacterial Adult: Common side Tendinitis/ten Hypersensitivit  Lab tests:
LEVOFLOXACI infections including ≥18yrs (CrCl effects: nausea, don rupture, y to Do C&S test
N acute bacterial sinusitis ≥50mL/min): headache, peripheral levofloxacin prior to
(ABS), acute bacterial Regimen depends diarrhea, neuropathy, and quinolone beginning
exacerbations of on pathogen type insomnia CNS effects, antibiotics; therapy and
Brand Name chronic bronchitis (see full labeling). (trouble hypersensitivi hypokalemia, periodically.
LEVAQUIN (ABECB), nosocomial Oral soln: take on sleeping), ty reactions, tendon pain,  Withhold
or community-acquired empty stomach. IV: constipation, hepatotoxicit pregnancy therapy and
pneumonia (CAP), infuse over 60 mins dizziness y, C. difficile- (category C); report to
UTIs, acute (250mg or 500mg), associated syphilis; viral physician
pyelonephritis, chronic or over 90 mins diarrhea, infections; immediately any
bacterial prostatitis, (750mg). ABS: torsades de phototoxicity; of the following:
skin and skin structure 500mg once daily pointes, lactation. Skin rash or
infections. Inhalation for 10–14 days or dysglycemia, other signs of a
anthrax (post- 750mg once daily phototoxicity, hypersensitivity
exposure): to reduce for 5 days. aortic reaction; (CNS
incidence or ABECB: 500mg aneurysm/dis symptoms such
progression of disease once daily for 7 section. as seizures,
RESPIRATORY DRUGS
(see full labeling). days. Nosocomial Children: also restlessness,

Plague. For ABS, pneumonia: 750mg musculoskele confusion,
ABECB, and once daily for 7–14 tal disorders. hallucinations,
uncomplicated UTIs: days. CAP: 500mg depression; skin
reserve for those who once daily for 7–14 eruption
have no alternative days or 750mg following sun
treatment options. once daily for 5 exposure;
days. symptoms of
Uncomplicated colitis such as
skin and skin persistent
structure: 500mg diarrhea; joint
once daily for 7–10 pain,
days; complicated: inflammation, or
750mg once daily rupture of a
for 7–14 days. tendon;
Prostatitis: 500mg hypoglycemic
once daily for 28 reaction in
days. diabetic on an
Uncomplicated oral
UTIs: 250mg once hypoglycemic
daily for 3 days. agent.
Complicated UTIs,  Learn
acute important
pyelonephritis: indications for
250mg once daily discontinuing
for 10 days or drug and
750mg once daily immediately
for 5 days. notifying
Postexposure physician.
inhalational  Consume
anthrax: 500mg fluids liberally
once daily for 60 while taking
days (start as soon levofloxacin.
as possible after  Allow a
exposure). Plague: minimum of 2 h
500mg once daily between drug
RESPIRATORY DRUGS
for 10–14 days. dosage and

Renal impairment taking any of the
(CrCl <50mL/min): following:
adjust dose. Aluminum or
Children: magnesium
<6mos: not antacids, iron
established. ≥6mos: supplements,
Inhalation anthrax multivitamins
(post–exposure): with zinc, or
<30kg: use other sucralfate.
forms; 30–<50kg:  Avoid
250mg every 12hrs exposure to
for 60 days; ≥50kg: excess sunlight
500mg once daily or artificial UV
for 60 days. light.
Plague: <30kg: use  Avoid NS
other forms; 30– AIDs while
<50kg: 250mg taking
every 12hrs for 10– levofloxacin, if
14 days; ≥50kg: possible.
500mg once daily  Do not
for 10–14 days. breast feed while
taking this drug.

Generic Name Mild to moderate Adult: Common side Abdominal Hypersensitivit • Inquire about
CLARITHROM susceptible Pharyngitis/tonsillit effects: pain, y to previous
YCIN pharyngitis/tonsillitis, is: 250mg every diarrhea. diarrhea, clarithromycin, hypersensitivity to
acute bacterial 12hrs for 10 days. nausea. nausea, erythromycin, other macrolides
exacerbation of chronic Bronchitis: vomiting. vomiting, or any other (e.g.,
Brand Name bronchitis, community- 250mg–500mg stomach pain. dysguesia; macrolide erythromycin)
BIAXIN acquired pneumonia, every 12hrs for 7– heartburn. hepatotoxicit antibiotics; before treatment.
acute maxillary 14 days. CAP, skin gas. y, patients • Withhold drug
sinusitis, acute otitis and skin structures: change in taste. QT receiving and notify
media, uncomplicated 250mg every 12hrs headache. prolongation, pimozide; physician, if
RESPIRATORY DRUGS
skin and skin structure for 7–14 days. C. difficile- suspected or hypersensitivity
infections. Sinusitis: 500mg associated potential occurs (e.g., rash,
Disseminated M. every 12hrs for 14 diarrhea, bacteremias; urticaria).
intracellulare. days. MAC: 500mg hypersensitivi acute • Monitor for and
Treatment (with other every 12hrs; ty reactions. porphyria; report loose stools
antimycobacterials) and continue severe hepatic or diarrhea, since
prophylaxis of indefinitely if or biliary pseudomembranou
disseminated Mycobact improvement disease; s colitis must be
erium avium complex occurs. Severe pregnancy ruled out.
(MAC). renal impairment (category C). • When
(CrCl <30mL/min): Safety and clarithromycin is
reduce efficacy in given concurrently
clarithromycin children <6 y with
dose by ½. When not established. anticoagulants,
moderate or severe digoxin, or
renal impairment theophylline, blood
and concomitant levels of these
atazanavir or drugs may be
ritonavir: reduce elevated.
clarithromycin • Monitor
dose by ½ (CrCl appropriate serum
30–60mL/min) or levels and assess
¾ (CrCl for S&S of drug
<30mL/min). toxicity.
Children:
<6 months: not
established. Otitis
media,
pharyngitis/tonsillit
is, pneumonia,
sinusitis, skin and
skin structures:
7.5mg/kg every
12hrs for 10 days.
MAC (see full
labeling): 7.5mg/kg
RESPIRATORY DRUGS
every 12hrs; max

500mg every
12hrs, continue
indefinitely if
improvement
occurs.
Generic Name Mild-to-moderate Adult: Common side Diarrhea, Contraindicate • Monitor for and
AZITHROMYCI susceptible infections Use packets only effects: nausea, d in patient report loose stools
N including acute for doses equal to diarrhea or loose abdominal with: or diarrhea, since
bacterial exacerbations 1g. COPD: 500mg stools, pain, Ketolide pseudomembranou
of COPD, acute once daily for 3 nausea, vomiting, r allergy. s colitis (see
Brand Name bacterial sinusitis, acute days; or 500mg abdominal pain, ash; History of Appendix F) must
ZITHROMAX otitis media, once for 1 day, stomach upset, hepatotoxicit cholestatic be ruled out.
community-acquired then 250mg once vomiting, y, jaundice/hepati • Monitor PT and
pneumonia, daily for 4 days. constipation, torsade de c dysfunction INR closely with
pharyngitis/tonsillitis, Sinusitis: 500mg dizziness, pointes (esp. associated with concurrent
uncomplicated skin and once daily for 3 tiredness, elderly), C. prior use. warfarin use.
skin structure, days. Community- headache, difficile assoc • Direct sunlight
urethritis, cervicitis, acquired vaginal iated (UV) exposure
chancroid in men. pneumonia, itching or discha diarrhea; should be
Treatment and pharyngitis/tonsillit rge, rare: allergic minimized during
prophylaxis is, skin and skin nervousness, reactions (eg, therapy with drug.
of Mycobacterium structure: 500mg sleep problems angioedema, • Take aluminum
avium complex (MAC) once for 1 day, (insomnia), AGEP, or magnesium
infection then 250mg once skin rash or itchi Stevens- antacids 2 h before
daily for 4 days. ng, Johnson or after drug.
Nongonococcal ringing in the syndrome, • Report onset of
urethritis, ears, toxic loose stools or
cervicitis, hearing epidermal diarrhea.
chancroid: 1g as a problems, necrolysis, • Do not breast
single dose. or DRESS), lab feed while taking
Urethritis, decreased sense abnormalities. this drug without
cervicitis due to N. of taste or smell. consulting
gonorrhoeae: 2g as physician.
RESPIRATORY DRUGS
a single dose.
MAC prevention
(alone or combined
with rifabutin):
1200mg once
weekly. MAC
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 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
RESPIRATORY DRUGS
(max 500mg) once

for 1 day, then
5mg/kg (max
250mg) once daily
for 4 days.
Pharyngitis/tonsillit
is: <2yrs: not
established; ≥2yrs:
12mg/kg (max
500mg) once daily
for 5 days.

Generic Name Treatment of Adult: Blistering, GI: Nausea, Hypersensitivit • Report onset of
ERYTHROMYC susceptible infections Give preferably peeling, or vomiting, y to GI symptoms after
IN including upper and 2hrs before meals. loosening of the abdominal erythromycins. PO administration
lower respiratory, skin Usual dose: 333mg skin cramping, dia Estolate: Histor to physician. These
and skin structure, every 8hrs or chills rrhea, y of are dose related; if
Brand Name genitourinary, 500mg every cough heartburn, erythromycin- symptoms persist
ERYTHROCIN Legionnaires' disease, 12hrs; max 4g/day diarrhea anorexia. associated after dosage
pertussis, listeriosis. (1g/day for twice difficulty with Body as a hepatitis; liver reduction,
Prophylaxis for daily dosing). swallowing Whole: Fever dysfunction; physician may
rheumatic fever attacks Legionnaires: 1–4g dizziness , eosinophilia, treatment of prescribe drug to
in penicillin-allergic daily in divided fast heartbeat urticaria, skin skin disorders be given with
patients. doses. Prophylaxis: hives or welts, s eruptions, such as acne or meals in spite of
250mg twice daily. kin rash fixed drug furunculosis; impaired
Children: joint or muscle eruption, prophylaxis of absorption.
Give preferably pain anaphylaxis. rheumatic • Monitor for
2hrs before meals. puffiness or Superinfectio fever. adverse GI effects.
Usual dose: 30– swelling of the ns by Pseudomembranou
50mg/kg/day in eyelids or nonsusceptibl s enterocolitis (see
divided doses; may around the eyes, e bacteria, Appendix F), a
double dose in face, lips, or yeasts, or potentially life-
severe infections. tongue fungi. threatening
Max 4g/day. red, irritated Special condition, may
RESPIRATORY DRUGS
eyes Senses: Ototo occur during or

red skin lesions, xicity: after antibiotic
often with a reversible therapy.
purple center bilateral • Observe for S&S
redness of the hearing loss, of superinfection
skin tinnitus, by overgrowth of
sore throat vertigo. nonsusceptible
sores, ulcers, or Digestive: (E bacteria or fungi.
white spots in stolate) Emergence of
the mouth or on Cholestatic resistant
the lips hepatitis staphylococcal
tightness in the syndrome. strains is highly
chest Skin: (topical predictable during
unusual use) prolonged therapy.
tiredness or Erythema, • Lab tests:
weakness desquamation Periodic liver
, burning, function tests
tenderness, during prolonged
dryness or therapy.
oiliness, • Monitor for S&S
pruritus. of hepatotoxicity.
Premonitory S&S
include:
Abdominal pain,
nausea, vomiting,
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
RESPIRATORY DRUGS
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.
Generic Name Susceptible infections Adult: Common side GI upset, Hypersensitivit • Determine
AMOXICILLIN including ENT, effects: diarrhea hypersensitivi y to penicillins; previous
ear/nose/throat (ENT), genitourinary, or stomach upset ty reactions infectious hypersensitivity
genitourinary tract, skin skin: 250mg every headache (eg, urticaria, mononucleosis. reactions to
Brand Name and skin structures, 8hrs. Severe, less abnormal taste rash, Stevens- penicillins,
AMOXIL lower respiratory, acute susceptible, or sense Johnson cephalosporins,
uncomplicated lower respiratory skin rash syndrome, and other allergens
gonorrhea. infections: 500mg vaginal yeast anaphylaxis), prior to therapy.
every 8hrs. infection hyperactivity, • Lab tests:
Gonorrhea: 3g blood Baseline C&S tests
once. Renal dyscrasias. prior to initiation
impairment: of therapy, start
glomerular drug pending
filtration rate results; periodic
RESPIRATORY DRUGS
(GFR) 10– assessments of

30mL/min: 250mg renal, hepatic, and
or 500mg every hematologic
12hrs; GFR functions should
<10mL/min or be made during
hemodialysis: prolonged therapy.
250mg or 500mg • Monitor for S&S
every 24hrs (give of an urticarial
additional dose rash (usually
during and at end occurring within a
of dialysis). few days after start
Children: of drug) suggestive
≥40kg: as adult. ≤3 of a
months: max hypersensitivity
30mg/kg per day in reaction. If it
2 divided doses occurs, look for
every 12hrs. >3 other signs of
months (<40kg): hypersensitivity
ENT, (fever, wheezing,
genitourinary, skin: generalized
20mg/kg per day in itching, dyspnea),
3 divided doses and report to
every 8hrs. Severe, physician
less susceptible, or immediately.
lower respiratory • Report onset of
infections: generalized,
40mg/kg per day in erythematous,
3 divided doses maculopapular
every 8hrs. rash (ampicillin
Gonorrhea: <2yrs: rash) to physician.
not recommended; Ampicillin rash is
prepubertal: not due to
amoxicillin hypersensitivity;
50mg/kg + however,
probenecid hypersensitivity
25mg/kg as a should be ruled
RESPIRATORY DRUGS
single dose. out.

• Closely monitor
diarrhea to rule out
pseudomembranou
s colitis.
Generic Name Susceptible moderately Adults and Common side Rash, Hypersensitivit • Obtain an exact
PENICILLIN severe infections Children: effects: drug fever, y to any of the history of patient's
including respiratory, Give by deep IM nausea serum penicillins or previous exposure
skin and soft tissue, inj into upper, vomiting sickness, cephalosporins and sensitivity to
Brand Name erysipelas, scarlet fever, outer buttock stomach upset anaphylaxis, ; penicillins and
BICILLIN C-R otitis media. (dorsogluteal) or diarrhea blood administration cephalosporins and
ventrogluteal site; black hairy dyscrasias, of oral drug to other allergic
for younger tongue neuropathy, patients with reactions of any
children, midlateral nephropathy, severe kind prior to
thigh may be in site infections; treatment with
preferred. Group A reactions, nausea, penicillin.
strep: <30lbs: methemoglob vomiting, • Hypersensitivity
600,000 units; 30– inemia, C. hypermotility, reactions are more
60lbs: 900,000–1.2 difficile- gastric likely to occur
million units; associated dilatation; with parenteral
>60lbs: 2.4 million diarrhea. cardiospasm. penicillin but may
units; all as single Use of also occur with the
dose (may split penicillin G oral drug. Skin
injections) or may sodium in rash is the most
give one-half total patients on common type
dose on day 1 and sodium allergic reaction
one-half on day 3. restriction. and should be
Pneumococcal Safety during reported promptly
(except meningitis) pregnancy to physician.
children: 600,000 (category B) or • Lab tests:
units; adults 1.2 lactation is not Perform C&S tests
million units; give established. prior to initiation
every 2–3 days of therapy;
until afebrile for treatment may be
RESPIRATORY DRUGS
48hrs. 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
RESPIRATORY DRUGS
sudden fever.
Report 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.
ASTHMA DRUGS
RESPIRATORY DRUGS

Generic Name To prevent or treat Intravenous Common side Tremor Contraindicate • May decrease the
ALBATEROL bronchospasm in infusion solution: effects: Nervousness d in patients effectiveness of
patients with reversible -Dilute 5 mL of headache, Headache hypertensive to Beta Blockers
obstructive this drug (1000 dizziness, Hyperactivity drug or it’s • Use caution with
Brand Name airway disease. mcg/mL) in 500 sleep problems Insomia ingredients. heart disease
ACCUNEB mL of Sodium (insomnia), Dizziness diabetes
Chloride Injection, cough, weakness glaucoma
or Sodium hoarseness, malaise seizure disorder
Chloride and sore throat, • Overuse of
Dextrose. runny or stuffy inhalers can lead to
-Infusion rates can nose, bronchospasm
be started at 5 nausea, • Monitor for chest
mcg/min, and can vomiting, pain and
be increased to 10 dry mouth and palpitations
mcg/min and 20 throat, • Monitor the
mcg/min at 15 at muscle pain, or decrease digoxin
30 minute diarrhea. levels
intervals, if
necessary.
Nebulizer
inhalation solution:
-2.5 mg three or
four times a day by
nebulization, over
approximately 5 to
15 minutes.
Generic Name Long term maintenance Asthma Prevention Cough Anxiety Hypersensitivit • Instruct patient to
SALMETEROL of asthma; to prevent and Maintenance producing tremor y is a avoid excessive
bronchospasm in Administer as mucus nervousness contraindicatio use
patients with nocturnal additional therapy difficulty with sleep n for • Can cause
Brand Name asthma. for patients breathing disturbance salmeterol. It is headache
SEREVENT currently taking but headache fever contraindicated palpitations
RESPIRATORY DRUGS
DISKUS inadequately irritation of the paresthesia in patients with tachycardia,

controlled on an throat a known abdominal pain,
inhaled runny nose hypersensitivit paradoxical
corticosteroid sneezing y to any bronchospasm
(ICS); not for stuffy nose ingredient in • Beta blockers and
patients whose tightness in the the decrease
asthma is chest preparation, effectiveness
adequately including assess respiratory
controlled on low- lactose and status
or medium-dose milk protein. • Beta blockers
ICS and decrease
1 inhalation (50 effectiveness
mcg) twice daily; • Assess
not to exceed twice respiratory status
daily • May increase
administration glucose levels
Prevention of always take
Exercise-Induced bronchodilator
Asthma first.
Use as a single
agent for the
prevention of EIB
may be clinically
indicated in
patients who do not
have persistent
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-
RESPIRATORY DRUGS
daily therapy of
salmeterol

Generic Name Treatment of allergic The Initial dose or Common side Body as a Hypersensitivit • Monitor closely
BUDESONIDE and perennial rhinitis, during periods of effects may Whole: Arthr y to for S&S of
(BRAND NAME maintain remission in severe asthma or include: algia, fatigue, budesonide, hypercorticism if
SYMBICORT) mild to moderate while reducing oral headache; fever, lactation. concomitant doses
Crohn's disease; corticosteroids: nausea, hyperkinesis, of ketoconazole or
prophylaxis for asthma. Adult: 1-2 mg stomach pain, myalgia, other CYP3A4
Brand Name twice daily; gas, bloating, asthenia, inhibitors (see
ENTOCORT Children one year constipation; paresthesia, Drug Interactions)
and above: 500 feeling tired; tremor. CNS: are being given.
mcg-1 mg twice joint pain; Dizziness, • Monitor patients
daily. Maintenance acne; or. emotional with moderate to
dose: The cold symptoms lability, facial severe liver disease
maintenance dose such as stuffy edema, for increased S&S
should be nose, sneezing, nervousness, of hypercorticism.
individualized. sore throat. headache, agi • Lab tests:
After the desired tation, Periodic serum
clinical effect has confusion, potassium.
been obtained, the insomnia,
maintenance dose drowsiness. C
should be gradually V: Chest
reduced to the pain,
smallest amount hypertension,
necessary for palpitations,
control of sinus
symptoms. tachycardia.
Adults: 0.5-1 mg GI: Abdomin
twice daily. al pain,
Children one year dyspepsia,
and above: 0.25- gastroenteritis
0.5 mg twice daily. , oral
Once daily dosage: candidiasis,
RESPIRATORY DRUGS
Once daily dosing xerostomia,

may be considered diarrhea,
for those patients nausea,
who require a vomiting,
maintenance dose cramps. Hem
of 0.25-1 mg atologic: Epis
Budesonide per taxis. Metabo
day. lic: Hypokale
Patients dependent mia, weight
on oral steroids: gain. Respirat
When transferring ory: Bronchos
patient form oral pasms, infecti
steroids to ons, cough,
Budesonide rhinitis,
respule, the patient sinusitis,
should be in dyspnea,
relative stable hoarseness,
phase. As high wheezing. Ski
dose of Budesonide n: Eczema,
respule is given in pruritus,
combination with purpura, rash,
the previously used alopecia. Spe
steroid or about 10 cial
days. After that, the Senses: Conta
oral dose is ct dermatitis,
gradually reduced reduced sense
to the lowest of smell,
possible level. nasal
pain. Urogeni
tal: Intermens
trual
bleeding,
dysuria.
Generic Name Acute asthma Adults and Common side Palpitations Contraindicate • If patient uses
RESPIRATORY DRUGS
IPRATROPIUM exacerbations, in adolescents age 13 effects: Chest pain d in patient face mask for a
combination with short and older. dry mouth, HTN with a history nebulizer, take
acting beta agonist. 500 mcg via oral cough, Blurred of care to prevent
Brand Name nebulizer every 20 headache, vision hypersensitivit leakage around the
ATROVENT minutes for three nausea, y to soya mask because eye
HFA doses, then as dizziness, and lecithin or pain or temporary
needed: or 8 difficulty breathi related food blurring of vision
inhalation aerosol ng. such as may occur.
every 20 minutes soybean and • Safety and
as needed for up to peanut. effectiveness of
3 hours. Aerosol should intranasal use
Children ages 6 to also not be beyond 4 days in
12: taken by patients with a
250 to 500 mcg patients common cold
via oral nebulizer hypersensitive haven’t been
every 20 minutes to any other established.
for three doses, components of
then as needed; or the drug
4 to 8 inhalations product or to
aerosol every 20 atropine or it’s
minutes as needed derivatives.
for up to 3 hours.
Children age 5 and
younger:
250 mcg via oral
nebulizer every 20
minutes for I hour:
or 2 inhalations of
inhalation of
aerosol every 20
minutes if needed
for 1 hour.
Generic Name Indicated for the long- Adult Common side Constipation, Tiotropium • Do not allow
TIOTROPIUM term, once-daily, Inhalation COPD; effects: upset bromide is powdered
RESPIRATORY DRUGS
maintenance treatment Asthma As dry mouth, sore stomach, contraindicated medication to

of bronchospasm inhalation cap: 1 throat, cough, vomiting, in patients with contact the eyes, as
associated with chronic cap (18 mcg)/day sinus problems, cold a hypersensitiv this may cause
Brand Name obstructive pulmonary via inhaler device, constipation, symptoms ity to blurring of vision
TIOTROPIUM disease (COPD), at the same time fast heart rate, (stuffy nose, tiotropium, and pupil dilation
BROMIDE including chronic each day. As blurred vision or sneezing, sore ipratropium, •
bronchitis and inhalation soln: 2 vision changes, throat), and atropine Tiotropium bromid
emphysema. inhalations (5 pain with nosebleed, or. (due to the risk e is intended as a
mcg)/day, at the urination. muscle pain. of anaphylaxis) once-daily
same time each and narrow- maintenance
day. angle glaucom treatment
a. Powder • Withhold drug
tiotropium and notify
capsules physician if
contain milk swelling around
protein and are the face, mouth, or
contraindicated neck occurs.
for use in
patients
with allergies t
o milk.

Generic Name As preventive in Adult and Common side Headache Patient with • You can take this
FLUTICASONE maintenance of chronic Adolescent Patients effects: dizziness hypertension, drug with or
asthma in patients Aged 12 Years and upper fever immediate without food.
requiring oral Older respiratory tract migraine hypersensitivit • Take your doses
Brand Name corticosteroid. The recommended infection nervousness y reactions, 12 hours apart.
FLOVENT starting dosage for throat, nose, including • Monitor patient,
patients aged 12 and/or sinus anaphylaxis, especially
years and older irritation can occur postoperatively,
who are not on an nausea and Contraindicate during periods of
inhaled corticostero vomiting d as primary stress or severe
id is 100 mcg twice cough and/or treatment of attack of asthma
daily, persistent cough patients with for inadequate
RESPIRATORY DRUGS
approximately 12 fever status adrenal response

hours apart. For headache asthmaticus or • Advise patient to
other patients, and upset stomach other acute, report all adverse
for patients who do intense reactioc ns.
not respond episodes of
adequately to the asthma.
starting dosage
after 2 weeks of
therapy, 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
RESPIRATORY DRUGS
therapy, increasing
the dosage to 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.
Generic Name As a preventative in Adult: Common side Nasopharyngi Primary • Taper systemic
BUDESONIDE maintenance of asthma. Allow effects: tis treatment of steroids carefully
approx.12hrs headache, pharyngeal status during transfer to
between doses. throat irritation, pain, asthmaticus or inhalational
Brand Name Asthma: Base nausea, sinusitis, acute attacks of steroids; deaths
SYMBICORT initial dose on vomiting, nasal asthma or from adrenal
asthma severity. 2 stomach upset, congestion COPD insufficiency have
inh of 80/4.5 or diarrhea, oral requiring occurred.
160/4.5 twice daily back pain, candidiasis, intensive • Arrange for use
(AM & PM). If stuffy nose, upper measures. of decongestant
insufficient muscle or joint respiratory nose drops to
response after 1–2 pain, or infection facilitate
weeks using 80/4.5 changes in your flu penetration if
strength, may voice. back pain, edema, excessive
switch to 160/4.5 stomach secretions are
strength. Max 2 inh discomfort, present.
of 160/4.5 twice vomiting • Prime unit before
daily. Titrate to hypersensitivi use for Pulmicort
lowest effective ty reactions. Turbuhaler; have
strength after patient rinse mouth
adequate response. after each use.
COPD: 2 inh of • Use aerosol
RESPIRATORY DRUGS
160/4.5 twice within 6 mo of

daily. Rinse mouth opening. Shake
after use. well before each
Children: use.
Allow approx. •Store Respules up
12hrs between right and protected
doses. Asthma: from light; gently
<6yrs: not shake before use;
established. 6– open envelopes
<12yrs: 2 inh of should be
80/4.5 twice daily discarded after 2
(AM & PM). Rinse wk.
mouth after use.
COPD: not
indicated.

Generic Name Treatment for Chronic Adults and children Beclomethasone CNS: Contraindicate • Check mucous
BECLOMETHA asthma age 12 and older: inhalation may headache. d in patients membranes
SONE Starting dose, 40 to cause side EENT: hypersensitive frequently for
80 mcg b.i.d. when effects. Tell hoarseness, to drug or its signs and
previously used your doctor if throat ingredients and symptoms of
Brand Name bronchodilators any of these irritation, in those with fungal infection.
QVAR 40, QVAR alone, or 40 to 160 symptoms are fungal status • During times of
80 mcg b.i.d. when severe or do not infection of asthmaticus, stress (trauma,
previously used go away: throat. GI: nonasthmatic surgery, or
inhaled headache. fungal bronchial infection),
corticosteroids. sore throat. infection of diseases, or systemic
Maximum, 320 runny or stuffy mouth, dry asthma corticosteroids
mcg b.i.d. Children nose. mouth. controlled by may be needed to
ages 5 to 11: 40 back pain. Musculoskele bronchodilator prevent adrenal
mcg b.i.d., up to 80 nausea. tal: back pain. s or other insufficiency in
mcg b.i.d. cough. Respiratory: noncorticostero previously
difficult or cough, ids alone. Use corticosteroid-
painful speech. pharyngitis, cautiously, if at dependent patients.
RESPIRATORY DRUGS
rhinitis, upper all, in patients • Periodic

respiratory with measurement of
tract tuberculosis, growth and
infection, fungal or development may
exacerbation bacterial be needed during
of asthma, infections, highdose or
sinusitis, ocular herpes prolonged therapy
wheezing. simplex, or in children.
Other: systemic viral • Alert: Taper oral
angioedema, infections. Use corticosteroid
facial edema, cautiously in therapy slowly.
hypersensitivi patients Acute adrenal
ty reactions, receiving insufficiency and
adrenal systemic death may occur in
insufficiency, corticosteroid patients with
suppression therapy asthma who
of change abruptly
hypertension from oral
corticosteroids to
beclomethasone
Generic Name Asthma, seasonal For adults and Common side Headache Contraindicate • Monitor
MONTELUKAS allergic rhinitis, adolescents 15 effects: Asthenia d in patients effectiveness
T perennial rhinitis years of age and skin rash, Dizziness hypertensive to carefully when
older: one 10-mg mood changes, Fatigue drug or it’s used in
tablet. tremors, Fever ingredients. combination with
Brand Name For pediatric headache, Somnolence Contraindicate phenobarbital or
SINGULAIR patients 6 to 14 stomach pain, Weakness d in patients other potent
years of age: one 5- heartburn, with previous cytochrome P450
mg chewable upset stomach, sensitivity to enzyme inducers.
tablet. nausea, montelukast. • Lab test: Periodic
For pediatric diarrhea, Not used to liver function tests.
patients 2 to 5 tooth pain, treat acute • Do not use for
years of age: one 4- tiredness, asthma attack reversal of an
mg chewable tablet fever, and cannot acute asthmatic
RESPIRATORY DRUGS
or one packet of 4- stuffy nose, substitute attack.

mg oral granules. sore throat, inhaled or oral • Inform physician
For pediatric cough, corticosteroids. if short-acting
patients 12 to 23 and hoarseness. Monitor for inhaled
months of age: one eosinophilia, bronchodilators are
packet of 4-mg oral vasculitic rash, needed more often
granules. worsening of than usual with
Safety and pulmonary montelukast.
effectiveness in symptoms, • Use chewable
pediatric patients cardiac tablets (contain
less than 12 months complications phenylalanine)
of age with asthma and with caution with
have not been neuropathy. PKU.
established. • Do not breast
Patients who miss a feed while taking
dose should take this drug.
the next dose at
their regular time
and should not take
2 doses at the same
time.
Generic Name Moderate to severe Administer Common side Fever, muscle The use of • Promptly report
OMALIZUMAB persistent asthma in XOLAIR 75 mg to effects: aches, and XOLAIR is any of the
patients 6 years of age 375 mg by Headache, tired rash. contraindicated following:
and older who have a subcutaneous feeling, joint or in patients with bleeding or
Brand Name positive skin test or in injection every 2 or muscle pain, a severe unusual bruising,
XOLAIR vitro reactivity to a 4 weeks. dizziness, hypersensitivit difficulty breathing
perennial aeroallergen Determine dose ear pain, hair y reaction to or shortness of
and whose symptoms (mg) and dosing loss, sore throat, XOLAIR or to breath, skin rash or
are inadequately frequency by cold symptoms any ingredient hives. Do not
controlled with inhaled serum total IgE of XOLAIR. accept a live virus
corticosteroids. level (IU/mL) vaccine without
measured before consulting
the start of physician.
RESPIRATORY DRUGS
treatment, and by
body weight (kg).

Generic Name Mast-cell stabilizer; Oral Inhalation Common side Body as a Cromolyn sodi • Withhold drug
CROMOLYN used in adult and dosage (nebulized effects: Whole: Perip umproducts are and notify
pediatric patients 2 solution) headaches, heral contraindicated physician if any of
years and older Adults nasal irritation, eosinophilia, in those the following
Brand Name Nasal spray is used for Inhale 20 mg via cough, angioedema, patients who occur; angioedema
GASTROCROM allergic rhinitis; nebulization 4 wheezing, bronchospas have or bronchospasm.
ophthalmic solution times per day at dizziness, m, shown hyperse • Monitor for
used for allergic regular intervals. A nausea, body anaphylaxis (r nsitivity to exacerbation of
conjunctivitis; used 4 to 6-week trial aches, are). GI: Swel cromolyn sodiu asthmatic
orall for systemic may be necessary drowsiness. ling of m. symptoms
mastocytosis to determine parotid Acute broncho including
Nebulizer solution used maximum benefit. glands, dry spasm, status breathlessness and
for asthma control or Once asthma is mouth, asthmaticus. cough that may
exercise-induced stabilized, reduce slightly bitter occur in patients
bronchospasm, but is the dose to the after-taste, na receiving
not a preferred lowest effective usea, vomitin cromolyn during
treatment dose. The usual g, corticosteroid
decrease is from 4 esophagitis. C withdrawal.
to 3 times per day. NS: Headach • For patients with
Children and e, dizziness, asthma, therapeutic
Adolescents 2 peripheral effects may be
years and older neuritis. Skin: noted within a few
Inhale 20 mg via Erythema, days but generally
nebulization 4 urticaria, not until after 1–2
times per day at rash, contact wk of therapy.
regular intervals. A dermatitis. Sp
4- to 6-week trial ecial
may be necessary Senses: Sneez
to determine ing, nasal
maximum benefit. stinging and
Once asthma is burning, dryn
RESPIRATORY DRUGS
stabilized, reduce ess

the dose to the and irritation
lowest effective of throat and
dose. The usual trachea;
decrease is from 4 cough; nasal
to 3 times per day. congestion,
itchy, puffy
eyes,
lacrimation, tr
ansient ocular
burning,
stinging.
COPD DRUGS
Generic Name Long term maintenance Asthma Prevention Cough Anxiety Hypersensitivit • Instruct patient to
SALMETEROL of asthma; to prevent and Maintenance producing tremor y is a avoid excessive
bronchospasm in patients Administer as mucus nervousness contraindicatio use
with nocturnal asthma. additional therapy difficulty with sleep n for • Can cause
Brand Name for patients breathing disturbance salmeterol. It is headache
SEREVENT currently taking but headache fever contraindicated palpitations
RESPIRATORY DRUGS
DISKUS inadequately irritation of the paresthesia in patients with tachycardia,

controlled on an throat a known abdominal pain,
inhaled runny nose hypersensitivit paradoxical
corticosteroid sneezing y to any bronchospasm
(ICS); not for stuffy nose ingredient in • Beta blockers and
patients whose tightness in the the decrease
asthma is chest preparation, effectiveness
adequately including assess respiratory
controlled on low- lactose and status
or medium-dose milk protein. • Beta blockers
ICS and decrease
1 inhalation (50 effectiveness
mcg) twice daily; • Assess
not to exceed twice respiratory status
daily • May increase
administration glucose levels
Prevention of always take
Exercise-Induced bronchodilator
Asthma first.
Use as a single
agent for the
prevention of EIB
may be clinically
indicated in
patients who do not
have persistent
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-
RESPIRATORY DRUGS
daily therapy of
salmeterol.
Generic Name The combination of Powder for Headache, back Runny nose Active • Look for signs of
VILANTEROL fluticasone and vilanterol inhalation pain, sinusitis, and sore tuberculosis, sensitivity to the
is used to control 25mcg/100mcg per cough, urinary throat, upper herpes simplex medication. Signs
wheezing, shortness of actuation25mg/200 tract infection, respiratory infection of the consist of rash,
Brand Name breath, coughing, and mcg per actuation arthralgia, tract eye thrush an itching, swelling of
FLUTICASONE chest tightness caused Ellipta inhaler nausea, vertigo, infection, infection due the neck, and
FUROATE by asthma and chronic contains 2 double- abdominal pain, headache, to a parasite shortness of
obstructive pulmonary foil blister strips, 1 pleuritic pain thrush in your insufficiency breath. This can
(COPD; a group of containing mouth or of the occur at any point
diseases that affect the fluticasone furoate throat. Rinse hypothalamus during the course
lungs and airways, that and the other strip your mouth and pituitary of treatment.
includes chronic contains vilanterol; with water gland wide- • Observe the level
bronchitis and after the inhaler is without angle of symptom
emphysema). activated, the swallowing glaucoma severity to
powder within both after use to clouding of the determine if the
blisters is exposed help prevent lens of the eye medication is
and ready for this back pain called cataracts effective or if the
dispersion pneumonia osteoporosis. dose can be
bronchitis, decreased. This
inflammation includes how often
of the sinuses. one is sneezing,
the amount of
congestion there is,
and the color of
nasal discharge or
mucus.
• Taking
fluticasone for
long term
treatment places
one at risk for a
nasal infection or
RESPIRATORY DRUGS
sores in the
nostrils. This
should be assessed
by a doctor
specializing in the
ear, nose, and
throat (ENT).
• Growth in
children using
fluticasone for
long term
treatment can be
stunted. This
stresses the
importance of
using the lowest
effective dose.
• Hypothalamic-
pituitary-adrenal
(HPA) axis
suppression can
occur when using
fluticasone for
long term
treatment. The
HPA is responsible
for energy and
stress regulation in
the body using
communication
through the
hypothalamus,
pituitary gland,
and adrenal gland.
The body loses the
ability to manage
RESPIRATORY DRUGS
stressful situations
causing a crisis of
lethargy and
illness. Adrenal
function blood
tests should be
monitored when
taking fluticasone
for a long period
of time.

Generic Name As a preventative in Adult: Common side Nasopharyngi Primary • Taper systemic
BUDESONIDE maintenance of asthma. Allow effects: tis treatment of steroids carefully
approx.12hrs headache, pharyngeal status during transfer to
between doses. throat irritation, pain, asthmaticus or inhalational
Brand Name Asthma: Base nausea, sinusitis, acute attacks of steroids; deaths
SYMBICORT initial dose on vomiting, nasal asthma or from adrenal
asthma severity. 2 stomach upset, congestion COPD insufficiency have
inh of 80/4.5 or diarrhea, oral requiring occurred.
160/4.5 twice daily back pain, candidiasis, intensive • Arrange for use
(AM & PM). If stuffy nose, upper measures. of decongestant
insufficient muscle or joint respiratory nose drops to
response after 1–2 pain, or infection facilitate
weeks using 80/4.5 changes in your flu penetration if
strength, may voice. back pain, edema, excessive
switch to 160/4.5 stomach secretions are
strength. Max 2 inh discomfort, present.
of 160/4.5 twice vomiting • Prime unit before
daily. Titrate to hypersensitivi use for Pulmicort
lowest effective ty reactions. Turbuhaler; have
strength after patient rinse mouth
adequate response. after each use.
COPD: 2 inh of • Use aerosol
160/4.5 twice daily. within 6 mo of
RESPIRATORY DRUGS
Rinse mouth after opening. Shake

use. well before each
Children: use.
Allow approx. •Store Respules up
12hrs between right and protected
doses. Asthma: from light; gently
<6yrs: not shake before use;
established. 6– open envelopes
<12yrs: 2 inh of should be
80/4.5 twice daily discarded after 2
(AM & PM). Rinse wk.
mouth after use.
COPD: not
indicated.

Generic Name Indicated for the Adult: Inhalation A Common side Shakiness Formoterol • Monitor
FORMOTEROL treatment of asthma and sthma As effects: (tremor), fumarate is cardiovascular
in the prevention of inhalation cap: 12 Diarrhea nausea, contraindicated status with
bronchospasm only as mcg bid via inhaler Difficulty headache, ner in patients with periodic ECG, BP,
Brand Name concomitant therapy device, increased Sleeping vousness, a history of and HR
EFORMOTERO with a long-term asthma up to 24 mcg bid in Dizziness dizziness, dry hypersensitivit determinations.
L control medication, such severe cases. Dry Mouth mouth, troubl y to formoterol • Withhold drug
as an inhaled As metered-dose Headache e fumarate or to and notify
corticosteroid. dry powder inhaler: Nausea sleeping (inso any physician
6 or 12 mcg 1-2 Throat Irritation mnia), components of immediately of
times/day, up to 24 Vomiting anxiety, back this product. S&S of
mcg bid in severe pain, muscle bronchospasm.
cases. cramps, sore • Lab tests:
As metered-dose throat, cough, Monitor serum
aerosol: 12-24 mcg stuffy nose, potassium and
bid. Doses are skin rash, blood glucose
given in itching, or periodically.
combination w/ an changes in • Monitor diabetics
inhaled your voice. closely for loss of
RESPIRATORY DRUGS
corticosteroid. Prop glycemic control.

hylaxis of exercise-
induced asthma 12
mcg at least 15 min
prior to
exercise. COPD
As inhalation cap:
12 mcg bid via
inhaler device. As
metered-dose dry
powd inhaler: 12
mcg 1-2 times/day.
As metered-dose
aerosol: 12 mcg
bid. Max: 48
mcg/day (24
mcg/dose).
As soln for
nebulisation: 20
mcg bid.
Generic Name Treatment of smoking Adult: Provide Nausea (may Nausea, History of • Be alert for signs
VARENICLINE cessation; in conjunction patients with persist for other GI serious of depression or
with nonpharmacologic counseling and several months), effects (eg, hypersensitivit suicidal behaviors
support. educational stomach pain, constipation, y or skin and ideology.
Brand Name support. Set a indigestion, flatulence, reactions to Notify physician
CHANTIX target "quit date". constipation, vomiting), CHANTIX immediately if
Begin therapy 1 gas, sleep Contraindicate patient exhibits
week before target vomiting, disturbance d in patient these signs.
quit date. headaches, (eg, abnormal with: • Watch for signs
Alternatively, may weakness, dreams, schizophrenia of anemia,
begin therapy and tiredness, insomnia); manic- including unusual
then quit smoking unusual dreams, nicotine depression fatigue, shortness
between Days 8 sleep problems withdrawal suicidal of breath with
and 35 of (insomnia), symptoms thoughts exertion, bruising,
RESPIRATORY DRUGS
treatment. Take headache, dry (due to alcoholism and pale skin.

after eating with a mouth, or smoking alcohol Notify physician
glass of water. unpleasant taste cessation), intoxication immediately if
Initially 0.5mg in your mouth. neuropsychiat depression these signs occur.
once daily on Days ric symptoms a heart attack • Monitor signs of
1–3, then 0.5mg (may be a sudden hypersensitivity
twice daily on serious), worsening of reactions,
Days 4–7, then cardiovascula angina called including
1mg twice daily r events; acute coronary pulmonary
thereafter. May seizures, syndrome symptoms
reduce dose if somnambulis angina (tightness in the
intolerable nausea m, a type of chest throat and chest,
or other adverse angioedema, pain wheezing, cough,
effects occur. Treat hypersensitivi a transient dyspnea) or skin
for 12 weeks; may ty reactions, ischemic attack reactions (rash,
continue 12 more serious skin a type of stroke pruritus, urticaria).
weeks if patient reactions that lasts only a Notify physician if
successfully stops (rare); few minutes these reactions
smoking to further discontinue if a stroke occur.
increase the occurs. peripheral • Monitor anxiety,
likelihood of vascular irritability,
abstinence. Patients disease restlessness,
who are not able or severe renal agitation,
willing to quit impairment decreased
abruptly: consider a seizures attention,
gradual approach; increased increased
begin Chantix cardiovascular aggression,
dosing and reduce event risk hyperactivity, and
smoking by 50% other alterations in
from baseline mood or behavior.
within the 1st four Notify physician
weeks, by an promptly if these
additional 50% in symptoms
the next four develop.
weeks, and • Assess any joint
continue reducing pain, back pain, or
RESPIRATORY DRUGS
with the goal of muscle

complete pain/cramps to rule
abstinence by 12 out
weeks; continue for musculoskeletal
a total of 24 weeks pathology; that is,
of treatment. If try to determine if
patient motivated pain is drug
to quit and did not induced rather than
succeed, encourage caused by
another attempt anatomic or
with Chantix once biomechanical
factors contributing problems.
to failed attempt • Assess dizziness
have been and syncope that
addressed. Severe might affect gait,
renal impairment: balance, and other
initially 0.5mg functional
once daily; may activities
titrate to max (See Appendix C).
0.5mg twice daily. Report balance
ESRD with problems and
hemodialysis: max functional
0.5mg once daily if limitations to the
tolerated. physician, and
Children: caution the patient
≤16yrs: not and
recommended. 17– family/caregivers
19yrs: not to guard against
established. falls and trauma.

Generic Name Catapres is a prescription Adults Common side Withdrawal Contraindicate • Monitor BR
CLONIDINE medicine used to treat Initially, 0.1 mg effects: dry symptoms, d in patient closely. Determine
symptoms high blood PO twice daily. mouth, nervousness, with: positional changes
pressure, attention deficit Increase by 0.1 dizziness, agitation, Pregnancy (supine, sitting,
RESPIRATORY DRUGS
Brand Name hyperactivity mg/day at weekly drowsiness, headache, (category C), standing).
CATAPRES disorder (ADHD) and intervals until fatigue, tremor, and lactation. • With epidural
cancer pain. Catapres desired effect is constipation, rapid rise in Use of administration,
may be used alone or achieved (usual headache, blood clonidine patch frequently monitor
with other medications. range: 0.2 to 0.6 nausea, and pressure in polyarteritis BP and HR.
Catapres belongs to a mg/day). For trouble sleeping nodosa, Hypotension is a
class of drugs called unequal doses, (insomnia) scleroderma, common side
Alpha2 Agonists, taking the larger SLE. effect that may
Central-Acting, ADHD portion of the daily require
Agents. dose at bedtime intervention.
may minimize • Monitor BP
adverse events. closely whenever a
Although the drug is added to or
manufacturer withdrawn from
recommends a therapeutic
maximum dose of regimen.
2.4 mg/day, which • Monitor I&O
is rarely used, during period of
further dosage adjustment.
antihypertensive Report change in
benefit may not be I&O ratio or
achieved at doses change in voiding
above 1.2 mg/day. pattern.
Geriatric patients • Determine
may require a weight daily.
lower initial dose Patients not
due to increased receiving a
risk of side effects. concomitant
Children and diuretic agent may
Adolescents 12 gain weight,
years and older† particularly during
Initially, 0.1 mg first 3 or 4 d of
PO twice daily therapy, because of
titrated up based on marked sodium
clinical response and water
(Max: 2.4 mg/day). retention.
RESPIRATORY DRUGS
Increase by 0.1 • Supervise closely

mg/day at weekly patients with
intervals until history of mental
desired effect is depression, as they
achieved (usual may be subject to
adult range: 0.2 to further depressive
0.6 mg/day). For episodes.
unequal doses,
taking the larger
portion of the daily
dose at bedtime
may minimize
adverse events.
Children younger
than 12 years†
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.
Generic Name Indicated: Adults Common side Drowsiness, Contraindicate • Be aware that
NORTRIPTYLI For the treatment of Initially, 25 mg to effects: anticholinergi d in patient nortriptyline has a
NE major depression 50 mg PO per day, nausea c effects, with: narrow therapeutic
For the treatment of given in divided drowsiness CNS Acute recovery plasma level range,
social phobia (social doses or once daily weakness or overstimulati period after or "therapeutic
RESPIRATORY DRUGS
Brand Name anxiety disorder) or at bedtime. May be tiredness on, MI; during or window." Drug
PAMELOR panic disorder increased if needed excitement or arrhythmias, within 14 d of levels above or
For the treatment of and tolerated. Max: anxiety extrapyramid MAO inhibitor below the
premenstrual dysphoric 150 mg/day PO. nightmares al symptoms, therapy. therapeutic
disorder (PMDD) Geriatric Adults dry mouth hypo- or Children <12 window are
For the treatment Initially, 10 mg to changes in hypertension, y, associated with
of nocturnal enuresis 25 mg PO at appetite or nausea, pregnancy decreased rate of
For the treatment of bedtime. May weight changes in (category D), response.
postherpetic neuralgia increase as constipation blood sugar, lactation. • Therapeutic
tolerated to 30 mg difficulty photosensitivi response may not
to 50 mg per day, urinating ty, edema, occur for 2 wk or
in divided doses or frequent blood more.
once daily at urination dyscrasias, • Monitor BP and
bedtime. changes in sex jaundice. pulse rate during
Adolescents drive or ability adjustment period
Initially, 10 mg or excessive of TCA therapy. If
25 mg PO at sweating systolic BP falls
bedtime. May more than 20 mm
increase as Hg or if there is a
tolerated to 30 mg sudden increase in
to 50 mg per day, pulse rate,
given in divided withhold
doses or once daily medication and
at bedtime. notify the
Tricyclic physician.
antidepressants are • Notify physician
not drugs of choice if psychotic signs
for pediatric increase. Because
patients with of the small
depression; the therapeutic
quality of data to window, a
support efficacy substitute TCA
and safety in may be prescribed
adolescents is rather than an
considered increase in dosage.
marginal. • Inspect oral
RESPIRATORY DRUGS
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 that
may signal acute
attack (severe
headache, eye
pain, dilated
RESPIRATORY DRUGS
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.
Generic Name FORFIVO XL (bupropion Adult: Common side Weight loss, Hypersensitivit • Monitor for
BUROPION hydrochloride extended- Do not use for effects: dry weight gain. y to therapeutic
release tablets) is initiation mouth, CNS: Seizures bupropion; effectiveness. The
indicated for the treatment; use nausea, . The risk of history of full antidepressant
Brand Name treatment of major other bupropion insomnia, seizure seizure effect of drug may
WELLBUTRIN depressive disorder forms for initial dizziness, appears to be disorder; not be realized for
SR (MDD), as defined by the dose titration. sore throat, strongly current or 4 or more weeks.
Diagnostic and Statistical Swallow whole. abdominal pain, associated prior diagnosis • Close
Manual (DSM). One tab (450mg) agitation, with dose of bulimia or observation for
once daily. May be anxiety, (especially anorexia worsening of
used in patients tremor, >450 mg/d) nervosa; depression or
receiving heart palpitatio and may be concurrent suicidal
300mg/day of ns, increased by administration tendencies.
another bupropion sweating, predisposing of an MAO • Use extreme
forms for at least 2 ringing in the factors (e.g., inhibitor; caution when
weeks and ears, head trauma, head trauma; administering drug
requiring a muscle pain, CNS tumor) CNS tumor; to patient with
450mg/day dose. weight loss, or a history of recent MI; history of seizures,
Taper dose using urinary prior abrupt cranial trauma, or
RESPIRATORY DRUGS
another bupropion frequency, seizure; agita discontinuatio other factors

form prior to headache tion, n, predisposing to
stopping Forfivo or migraine, insomnia, dry anorexia seizures; during
XL. Switching from rash, mouth, nervosa, sudden and large
other bupropion infection, blurred bulimia increments in
forms at weakness/lack vision, nervosa, dose, seizure
450mg/day: give of energy, headache, children <18 y; potential is
equivalent dose of chest pain, dizziness, lactation. increased.
Forfivo XL once flushing, tremor. • Report significant
daily. Switching hot flashes, GI: Nausea, restlessness,
to/from MAOIs: constipation, vomiting, agitation, anxiety,
see full labeling. diarrhea, constipation. and insomnia.
Children: vomiting, CV: Tachycar Symptoms may
Not established. trouble dia. Skin: Ras require treatment
swallowing, h. or discontinuation
joint pain, of drug.
nervousness, • Monitor for and
drowsiness, report delusions,
memory hallucinations,
problems, psychotic
runny or stuffy episodes,
nose, confusion, and
cough, paranoia.
itching, • Lab tests:
hives, or Monitor hepatic
blurred vision. and renal function
tests while patient
is taking this drug.
Pangasinan State University

RESPIRATORY DRUGS
INSTITUTE OF NURSING
Bayambang Campus
Bayambang, Pangasinan
1st Sem, S.Y. 2020-2021
NCM 112 – CARE OF CLIENT WITH PROBLEM IN

OXYGENATION, FLUID, AND ELECTROLYTES, INFECTIOUS,
INFLAMAMTORY, AND IMMUNOLOGIC RESPONSE,
CELLULAR ABERRATION, ACUTE AND CHRONIC
Submitted by:
JAROLD H. PEREZ
(BSN 3-2)
Submitted to:
MR. WILBERT O. ROSARIO, MAN
(Clinical Instructor)

Drug Study - Perez, JH

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RESPIRATORY DRUGS

Ulcerative colitis the liver), optic neuritis, established. promptly.

ptococci(viridans prickling lassitude, pregnancy should not exceed

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

LFT results; serum potassium

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

mg/kg (up to 1 g) low blood weekly

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

infection in patients unable to swallow vomiting, loss of anemia, of baseline liver

isoniazid (see full eyes or skin, pain

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

20mg/kg once upset stomach, etiology susceptibility

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

for 7–14 days. tendon;

for 60 days. light.

cm strip of nose, voice conjunctival keratitis, given with

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

Interaction may pain when eosinophilia. of opioid

leukopenia, tract), such as

age 15 and older: roaring in the patients. or prolonged

the older adult;

hearing loss) and

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

pneumoniae, minutes every 12 changes. sensitivity with uncommon, life-

streptococci, or less: 10 mg/kg glossitis, reactions to during therapy,

30 min, for 7–10 d • Monitor patient

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

I&O ratio and

AMPICIN sinusitis, and q6h IV/IM 25–100 (erythema urticaria, and other allergens

and 100 mg/kg pain, swelling, b arrhea, drug pending

Bacterial urticaria. Uro therapy if

infections, neonatal as headaches, values and prolongation of QT

shortness of oliguria, followup

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

preventing certain grams diarrhea, myocarditis, hypersensitivit therapy. Perform

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

dizziness, CNS: Headac to improve.

erythema, function tests.

diarrhea or acute (bronchitis). PJP sensation, vomiting, diar and/or itching, wheezing,

few days after start

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

(see full labeling). days. Nosocomial Children: also restlessness,

for 10–14 days. dosage and

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

every 12hrs; max

(max 500mg) once

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

eyes Senses: Ototo occur during or

(GFR) 10– assessments of

single dose. out.

48hrs. started before

Effect ion Consideration

DISKUS inadequately irritation of the paresthesia in patients with tachycardia,

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

Once daily dosing xerostomia,

maintenance treatment Asthma As dry mouth, sore stomach, contraindicated medication to

Drug Indication Dosage Side Effects Adverse Contraindicat Nursing

approximately 12 fever status adrenal response