AMPIXICILLIN

DRUG STUDY
CONTRAINDICATION/
MEDICATION MECAHNISM OF INDICATION SIDE EFFECTS DRUG TO DRUG INTERACTION ADVERSE EFFECTS NURSING CONSIDERATION/
ACTION Patient Teaching
CONTRAINDICATIONS &
GENERIC NAME: Inhibits cell-wall Adults and CAUTIONS ADVERSE REACTIONS NURSING CONSIDERATIONS
Common side effects of • Contraindicated in patients
Amoxicillin synthesis during Children CNS: seizures, anxiety, • If large doses are given or if therapy is pro-
amoxicillin include: hypersensitive to drug or other
BRAND NAME: Amoxil bacterial weighing 40kg or penicillin.
confusion, agitation, longed, bacterial, or fungal superinfection
DRUG CLASS multiplication. more: 500 mg PO • Use cautiously in patients dizziness, reversible may occur, especially in elderly, debilitated, or
Therapeutic class: every 12 hours or  acute allergic reaction with other drug allergies hyperactivity, anxiety, immunosuppressed patients.
Antibiotics 250 mg every 8  anemia (especially to cephalosporins) insomnia, behavioral • CDAD, ranging from mild diarrhea to fatal
Pharmacologic class: hours. because of possible cross- changes. colitis, has been reported with nearly all
 elevated liver sensitivity.
Aminopenicillins Gl: diarrhea, nausea, antibacterial agents, including amoxicillin.
enzymes • Use cautiously in those with
*DOSAGE: 500mg/250mg mononucleosis because of high pseudomembranous colitis, Evaluate patient if diarrhea occurs.
 persistent superficial i
*FREQUENCY: Every risk of maculopapular rash, vomiting. • Amoxicillin usually causes fewer cases of
12hrs 500mg or 250mg PO nfections of the skin Dialyzable drug: Yes. GU: interstitial nephritis, diarrhea than ampicillin.
every 8 hours.  diarrhea Overdose S&S: Oliguric renal nephropathy. Hematologic: • Look alike-sounds alike: Don't confuse
failure. PREGNANCY-
*ROUTE: PO  headache agranulocytosis, leukopenia, amoxicillin with amoxapine. PATIENT
LACTATION-
 nausea REPRODUCTION: thrombocytopenia, TEACHING
 vomiting Use during pregnancy only if thrombocytopenic purpura, • Tell patient to take entire quantity of drug
clearly needed. anemia, eosinophilia, exactly as prescribed, even after feeling better.
 rash • Drug appears in human hemolytic anemia. Instruct patient to take drug with or without
 antibiotic-associated milk. Use cautiously in
Other: anaphylaxis, food. • Tell patient to notify prescriber if rash,
inflammation of breastfeeding women.
hypersensitivity reactions, fever, or chills develop. A rash is the most
the colon INTERACTIONS overgrowth of nonsusceptible common allergic reaction, especially if
 serum sickness-like Drug-drug. Hormonal organisms. allopurinol is also being taken.
contraceptives: May decrease • Tell parent to place drops directly on child's
reactions
contraceptive effectiveness.
Advise use of additional forms
tongue for swallowing or add to formula,
of contraception during milk, fruit juice, water, ginger ale, or other
penicillin therapy. cold drink for immediate and complete
Live-virus vaccines: May consumption.
decrease effectiveness of live-
virus vaccines. Concurrent use
isn't recommended.
Methotrexate: May increase
methotrexate serum
concentration. Monitor patient
closely for toxicity. Probenecid:
May increase levels of
amoxicillin and other
penicillins. Probenecid may be
used for this purpose.
Tetracyclines: May reduce
therapeutic action of penicillins.
Avoid administering together.
Warfarin: May enhance the
 anticoagulant effect. Use
together cautiously. Drug-herb.
Khat: May decrease
antimicrobial effect. Discourage
khat chewing or tell patient to
take drug 2 hours after khat
chewing.

FUROSEMIDE

DRUG STUDY

MEDICATION MECAHNISM OF ACTION INDICATION SIDE EFFECTS CONTRAINDICATION/ ADVERSE EFFECTS NURSING CONSIDERATION/
DRUG TO DRUG INTERACTION Patient Teaching
 CONTRAINDICATIONS &
GENERIC NAME: Furosemide For Edema  Low CAUTIONS CNS: vertigo, headache, NURSING CONSIDERATIONS:
furosemide dizziness, paresthesia,
inhibits blood  pressure • Contraindicated in weakness, restlessness, fever. Alert: Monitor weight, BP, and pulse rate
BRAND NAME: Lasix reabsorption of Na and Adults: 20 to
 Dehydration patients hypersensitive to CV: ortho- static hypotension, routinely with long-term use. Black Box Warning
DRUG CLASS: chloride mainly in the 80mg PO, daily in drug and in those with thrombophlebitis with IV Drug is potent diuretic and can cause severe
 Electrolyte
Therapeutic Class: medullary the morning. anuria. administration. diuresis with water and electrolyte depletion.
 Depletion
Antihypertensives portion of the ascending • Use cautiously in patients EENT: blurred or yellowed Monitor patient closely and adjust dose carefully.
 Jaundice, with hepatic cirrhosis and in vision, transient deafness, • If oliguria or azotemia develops or in- creases,
Pharmacologic Class: Loop of Henle.  Loss of hearing those allergic to tinnitus. drug may need to be stopped.
Loop Diuretics Excretion of sulfonamides. Alert: Drug Gl: abdominal discomfort and • Monitor fluid intake and output and
*DOSAGE: 20mg to 80mg  Ear pain
potassium and ammonia may cause tinnitus and pain, diarrhea, anorexia, electrolyte, BUN, and carbon dioxide levels
*FREQUENCY: Every 6 to  Tinnitus reversible or irreversible nausea, vomiting, constipation, frequently.
are also increased white
8 hours  Blurred hearing loss. Ototoxicity is pancreatitis. •Watch for signs of hypokalemia, such as muscle
uric acid
*ROUTE: PO vision/sensitivity associated with rapid GU: azotemia, nocturia, weakness and cramps.
excretion is injection, severe renal polyuria, frequent urination, • Consult prescriber and dietitian about at high-
to light
reduced. It impairment, use of higher- oliguria. Hematologic agranulo potassium diet or potassium supplements.
(photophobia)
increases than- recommended doses, cytosis, aplastic anemia, • Monitor glucose level in diabetic patients.
 Rash hypoproteinemia, or use leukopenia, thrombocytopenia, •Drug may not be well absorbed orally in
plasma-renin
levels and  Pancreatitis with other ototoxic drugs. anemia. patient with severe HF. Drug may need to be
 Nausea • Drug may exacerbate or Hepatic: hepatic dysfunction, given IV even if patient is taking other oral drugs.
secondary activate SLE. jaundice, increased liver • Monitor uric acid level, especially in patients
hyperaldosteronism may  Diarrhea, • Premature infants may be enzyme levels. Metabolic: with a history of gout.
result.  Furosemide  Abdominal pain at increased risk for volume depletion and • Monitor elderly patients, who are especially
reduces BP in  Dizziness. persistent patent ductus dehydration, asymptomatic susceptible to excessive diuresis, because
 Increased blood arteriosus with furosemide hyperuricemia, impaired circulatory collapse and thromboembolic
hypertensives as well as in
treatment during first weeks glucose tolerance, complications are possible.
normotensives.  It also sugar and uric of life. Dialyzable drug: No. hypokalemia, hypochloremic • Monitor patients with severe symptoms of
reduces pulmonary acid levels. Overdose S&S: alkalosis, hyperglycemia, urine retention due to bladder emptying
oedema before diuresis Dehydration, blood volume dilutional hyponatremia, disorders, prostate enlargement, or urethral
has set in. reduction, hypotension, hypocalcemia, narrowing or worsening of symptoms, especially
electrolyte imbalance. hypomagnesemia. during initial treatment.
PREGNANCY- Musculoskeletal: muscle • Drug may increase fetal birth weight. Monitor
LACTATION- spasm. Skin: dermatitis, fetal growth during pregnancy.
REPRODUCTION purpura, photosensitivity • Nephrocalcinosis and nephrolithiasis have
• There are no well- reactions, transient pain at IM occurred in premature infants and in children.
controlled studies in injection site, toxic epidermal younger than age 4 on long-term furosemide
pregnant women. Use necrolysis, SJS, erythema therapy. Monitor renal function and renal
during pregnancy only if multiforme. ultrasounds. Look alike-sound alike: Don't
potential benefit justifies confuse furosemide with torsemide. Don't
potential risk to the fetus. Other: gout. confuse Lasix with Lonox, Lidex, or Luvox.
• Drug appears in human PATIENT TEACHING
milk. Use cautiously in • Advise patient to take drug in morning to
breastfeeding women. prevent need to urinate at night. If a second dose
is needed, tell patient to take it in early afternoon,
INTERACTIONS Drug- 6 to 8 hours after morning dose.
drug: • Inform patient of possible need for potassium
or magnesium supplements.
Aminoglycoside antibiotics, • Instruct patient to stand slowly to prevent
cis- platin: May increase dizziness and to limit alcohol intake and
ototoxicity. strenuous exercise in hot weather to avoid
Use together cautiously. worsening dizziness upon standing quickly.
Amphotericin B, • Advise patient to report all adverse reactions
corticosteroids, and to immediately report ringing in ears, severe
corticotropin, metolazone: abdominal pain, or sore throat and fever; these
May increase risk of symptoms may indicate toxicity. Alert:
hypokalemia. Monitor Discourage patient from storing different types of
potassium level closely. drugs in the same container, increasing risk of
Antidiabetics: May decrease drug errors. (The most popular strengths of
hypoglycemic effects. furosemide and digoxin are white tablets that are
Monitor glucose level. about equal in size.)
Antihypertensives: May • Tell patient to consult prescriber or pharmacist
increase risk of hypotension. before taking OTC drugs.
Use together cautiously. • Teach patient to avoid direct sunlight and to
Decrease antihypertensive use protective clothing and sunblock because of
dose if needed. Cardiac risk of photosensitivity reactions.
glycosides, neuromuscular
blockers: May increase
toxicity of these drugs from
furosemide-induced
hypokalemia. Monitor
potassium level.
Chlorothiazide,
chlorthalidone,
hydrochlorothiazide,
indapamide, metolazone:
May cause excessive diuretic
response, causing serious
electrolyte abnormalities or
dehydration. Adjust doses
carefully and monitor
patient closely for signs and
symptoms of excessive
diuretic response.
Ethacrynic acid: May
increase risk of ototoxicity.
Avoid using together.
Lithium: May decrease
lithium excretion, resulting
in lithium toxicity. Monitor
lithium level. NSAIDs: May
inhibit diuretic response.
Use together cautiously.
Phenytoin: May decrease
diuretic effects of
furosemide. Use together
cautiously. Propranolol:
May increase propranolol
level. Monitor patient
closely. Salicylates: May
cause salicylate toxicity. Use
together cautiously.
Sucralfate: May reduce
diuretic and
antihypertensive effect.
Separate doses by 2 hours.
  Choose 1 dosage, frequency, and route
 For the nursing responsibilities and patient teaching, choose only those related to the route chosen

ACETAMINOPHEN

DRUG STUDY

MEDICATION MECAHNISM OF ACTION INDICATION SIDE EFFECTS CONTRAINDICATION/ ADVERSE EFFECTS NURSING CONSIDERATION/
DRUG TO DRUG INTERACTION Patient Teaching
GENERIC NAME: Thought to produce Mild pain and  Contraindicated in patients CNS: agitation (IV), anxiety, Nursing Consideration:
Acetaminophen analgesia by fever  Red, peeling hypersensitive to drug. IV fatigue, headache, insomnia,
form is contraindicated in pyrexia. Black box warning:
BRAND NAME: Acephen inhibiting or blistering CV: HTN, hypotension, Many OTC and prescribing products contain
patients with severe hepatic
DRUG CLASS: prostaglandin and Adults: 325 to skin impairment or severe active peripheral edema, periorbital acetaminophen; be aware of this when calculating total
Therapeutic Class: other substances that 650 mg PO every liver disease. edema, tachycardia (IV). daily dose.
Analgesics sensitize pain 4 to 6 hours. Or  rash Hematologic: hemolytic, anemia,
 Use cautiously in patients
leukopenia, neutropenia, Black box warning:
Pharmacologic Class: receptors. Drug may two extended- with any type of liver
pancytopenia, anemia. Hepatic: Use caution when prescribing, preparing, and
Para-aminophenol relieve fever through release caplets  hives disease, G6PD deficiency, administering IV acetaminophen to avoid dosing errors
jaundice.
chronic malnutrition,
derivatives central action in the PO every 8 Metabolic: hypoalbuminemia leading to accidental overdose and death. Be careful not to
 itching severe hypovolemia
(IV). Musculoskeletal: muscle confuse dose in milliGRAMS and dose in milliLITERS.
*DOSAGE:325 to 650 mg hypothalamic heat- hours. (dehydration, blood loos),
spasms, extremity pain (IV). Be sure to base dose on weight for patients weighing less
*FREQUENCY: every 4 to regulating center. Maximum, 3250  swelling of or severe renal impairment than 50 kg, to properly program infusion pump, and to
Respiratory: abnormal breath
6 hours mg daily unless the face, (CrC1 of 30 ml/minute or
sounds, dyspnea, hypoxia, ensure that total daily dose of acetaminophen from all
*ROUTE: PO under health less). sources doesn’t exceed maximum daily limit.
throat, atelectasis, pleural effusion,
care provider  Use cautiously in patients
pulmonary edema, stridor,
tongue, lips, with long term alcohol use  Consider reducing total daily dose and increasing
supervision, because therapeutic doses
wheezing (IV). Skin: rash,
eyes, hands, urticaria; infusion-site pain (IV), dosing intervals in patients with hepatic or renal
when 4 g daily cause hepatotoxicity in impairment.
feet, ankles, pruritus.
(immediate- these patients. Chronic
release) may be or lower legs alcoholics shouldn’t take
used. more than 2 g of Patient Teaching:
 hoarseness acetaminophen every 24
hours.  Tell parents to consult prescriber before giving
 difficulty Dialyzable drug: drug to children younger than age 2.
breathing or Unknown.  Advise parents that drug is only for short -term
Overdose S&S: Stage 1 (up use; urge them to consult prescriber if giving to
swallowing to 24 hours)- abdominal infants for longer than 3 days, children for longer
pain, diaphoresis, nausea, than 5 days, or adult for longer than 10 days.
vomiting ,malaise, pallor;
stage 2 (24 to 36 hours)- Black box warning
right upper quadrant pain , Advise patient or caregiver that many OTC products
elevated LFT results, contain acetaminophen and should be counted when
prolonged PT; stage 3 (72 to calculating total daily dose.
96 hours)- hepatic failure ,
encephalopathy, coma.  Tell patient to consult prescriber for fever lasting
longer than 3 days or recurrent fever. Alert: Warn
Pregnancy- Lactation- reproduction patient that high doses or unsupervised long-term
use can cause liver damage. Excessive alcohol use
 Use cautiously in pregnant may increase the risk of liver damage. Caution
and breastfeeding women. long-term alcoholics to limit drug to 2g//day or
Embryo- fetal risk is very less.
low.  Caution patient to contact health care provider if
 There are no studies of IV signs and symptoms of liver damage ( illogical
acetaminophen use in thinking, severe dyspepsia, jaundice, inability to
pregnant women. Use eat , weakness) occur. Alert: Warn patient to stop
during pregnancy only if drug and seek medical attention immediately if
clearly needed. rash or other reactions occurs while using
acetaminophen.
Drug to drug. Barbiturates,  Tell breastfeeding patient that drug appears in
carbamazepine, hydantoins, human milk low levels. Drug may be used safely
if therapy is short-term and doesn’t exceed
rifampin: High doses or long-term
 use of these drugs may reduce recommended doses.
therapeutic effects and enhance
hepatotoxic effects of
acetaminophen. Avoid using
together.
Busulfan: may increase busulfan
level. Monitor patients closely.
Cholestyramine resin: May
decrease acetaminophen
absorption. Give at least 1 hour
after acetaminophen or consider
therapy change.
Dasatinib: may enhance hepatotoxic
effects of dasatinib and increase
acetaminophen level. Avoid use
together.
Imatinib mipomersen: may increase
hepatotoxic effects of these drugs.
Monitor patients closely.
Isoniazid: may increase risk of
acetaminophen adverse effects.
Monitor patients closely.
Lamotrigine: prolonged
acetaminophen use may decrease
lamotrigine level. Monitor patients
for therapeutics effects; adjust
lamotrigine dosage as needed.
Lomitapide: may increase
lomitapide level. Limit maximum
adult dose of acetaminophen to 4 g
or less daily for 3 or fewer days per
week or consider therapy change.
Metyrapone, probenecid: may
increase acetaminophen level and
risk of hepatotoxicity. Avoid use
together.
Warfarin: may increase
hypoprothrombinemic effects with
long term use with high doses of
acetaminophen. Monitor INR
closely.
Drug-lifestyle. Alcohol use: may
increase risk of hepatic damage.
Discourage use together.

 Choose 1 dosage, frequency and route

 For the nursing responsibilities and patient teaching, choose only those related to the route chosen