Generic Name: Ampicillin Brand Name: Omnipen,Polycillin,Principen Dosage & Route: Maximum recommended dosage, 8 14 g/day (reserve 14 g for

serious infections, such as meningitis, septicemia); may be given IV, IM, or PO. Use parenteral routes for severe infections; switch to oral route as soon as possible. Indication: y Treatment of infections caused by susceptible strains of Shigella, Salmonella, Escherichia coli, Haemophilus influenzae, Proteus mirabilis, Neisseria gonorrhoeae, enterococci, gram-positive organisms (penicillin G sensitive staphylococci, streptococci, pneumococci) Meningitis caused by Neisseria meningitidis Unlabeled use: Prophylaxis in cesarean section in certain high-risk patients

y y

Contraindication/Adverse Reaction: Known hypersensitivity to any penicillin prohibits its use. Among the most serious adverse reactions are anaphylaxis, nausea, and diarrhea. Fever, rashes, allergic reactions, and suprainfection also may occur. Nursing Consideration: - Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, and WBCs) at beginning and throughout therapy. Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before therapy. First dose may be given before receiving results. Observe patients for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction. Caution patient to notify physician if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication. Instruct patient to notify physician if symptoms do not improve.

Generic Name: Gentamicin Sulfate Brand Name: Garamycin, Garamycin Ophthalmic, Genoptic Dosage and Route: Moderate to Severe Infection Adult: IV/IM 1.5 2 mg/kg loading dose followed by 3 5 mg/kg/d in 2 3 divided doses Intrathecal 4 8 mg preservative free q.d. Topical 1 2 drops of solution in eye q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d.

Child: IV/IM 6 7.5 mg/kg/d in 3 4 divided doses Intrathecal >3 mo, 1 2 mg preservative free q.d. Neonate: IV/IM 2.5 mg/kg q12 24h Acute Pelvic Inflammatory Disease Adult: IV/IM 2 mg/kg followed by 1.5 mg/kg q8h Prophylaxis of Bacterial Endocarditis Adult: IV/IM 1.5 mg/kg 30 min before procedure, may repeat in 8 h Child: IV/IM < 27 kg, 2 mg/kg 30 min before procedure, may repeat in 8 h Indication: Parenteral use restricted to treatment of serious infections of GI, respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic antimicrobial agents are ineffective or are contraindicated. Has been used in combination with other antibiotics. Also used topically for primary and secondary skin infections and for superficial infections of external eye and its adnexa. Contraindication/Adverse Reaction: History of hypersensitivity to or toxic reaction with any aminoglycoside antibiotic. Safe use during pregnancy (category C) or lactation is not established Special Senses: Ototoxicity (vestibular disturbances, impaired hearing), optic neuritis. CNS: neuromuscular blockade: skeletal muscle weakness, apnea, respiratory paralysis (high doses); arachnoiditis (intrathecal use). CV: hypotension or hypertension. GI: Nausea, vomiting, transient increase in AST, ALT, and serum LDH and bilirubin; hepatomegaly, splenomegaly. Hematologic: Increased or decreased reticulocyte counts; granulocytopenia, thrombocytopenia (fever, bleeding tendency), thrombocytopenic purpura, anemia. Body as a Whole: Hypersensitivity (rash, pruritus, urticaria, exfoliative dermatitis, eosinophilia, burning sensation of skin, drug fever, joint pains, laryngeal edema, anaphylaxis). Urogenital: Nephrotoxicity: proteinuria, tubular necrosis, cells or casts in urine, hematuria, rising BUN, nonprotein nitrogen, serum creatinine; decreased creatinine clearance. Other: Local irritation and pain following IM use; thrombophlebitis, abscess, superinfections, syndrome of hypocalcemia (tetany, weakness, hypokalemia, hypomagnesemia). Nursing Consideration: y Lab tests: Perform C&S and renal function prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity. Repeat C&S if improvement does not occur in 3 5 d; reevaluate therapy. Note: Dosages are generally adjusted to maintain peak serum gentamicin concentrations of 4 10 g/mL, and trough concentrations of 1 2 g/mL. Peak concentrations above 12 g/mL and trough concentrations above 2 g/mL are associated with toxicity. Draw blood specimens for peak serum gentamicin concentration 30 min 1h after IM administration, and 30 min after completion of a 30 60 min IV infusion. Draw blood specimens for trough levels just before the next IM or IV dose. Use nonheparinized tubes to collect blood.

y y

Generic Name: Cefuroxime Brand Name: Xorimix Dosage and Route: IM/IV: ADULTS, ELDERLY: 750 mg to 1.5 g every 8 hours. CHILDREN: 75-100 mg/kg/day divided every 8 hours. Maximum: 8 g/day. NEONATES: 50-100 mg/kg/day divided every 12 hours. PO: ADULTS, ELDERLY: 125-500 mg 2 times a day depending on the infection. Pharyngitis, Tonsillitis PO: CHILDREN 3 MONTHS-12 YEARS: Tablet: 125 mg every 12 hours. Suspension: 20 mg/kg/day in 2 divided doses.

Acute Otitis Media, Acute Bacterial Maxillary Sinusitis, Impetigo PO: CHILDREN 3 MONTHS-12 YEARS: Tablet: 250 mg every 12 hours. Suspension: 30 mg/kg/day in 2 divided doses. Bacterial Meningitis IV: CHILDREN 3 MONTHS-12 YEARS: 200-240 mg/kg/day in divided doses every 6-8 hours Perioperative Prophylaxis IV: ADULTS, ELDERLY: 1.5 g 30-60 minutes before surgery and 750 mg every 8 hours post operative. IM/IV: NEONATES: 20-100 mg/kg/day in divided doses every 12 hours. Indication: Cefuroxime is used to treat otitis media, respiratory tract, genitourniary tract, gynecologic, skin, and bone infections. It is also used in the treatment of speticemia, bacterial meningitis, gonorrhea, and other gonococcal infections. Cefuroxime can also be used for ampicillin-resistant influenza, perioperative prophylaxis, impetigo, acute bacterial maxillary sinusitis, and early Lyme disease. Contraindication/Adverse Reaction: Contraindicated in patients hypersensitive to drug or other cephalosporin. Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other beta lactam antibiotics CV: phlebitis, thrombophlebitis GI: diarrhea, anorexia, vomiting Hematologic: hemolytic anemia, thrombocytopenia, transient neutropenia, eosinophilia Skin: Rash,pruritus, urticaria. Urogenital: Increased serum creatinine andBUN, decreased creatinine clearance Nursing Consideration: y y y y y y y y y y Question for history of allergies, particularly cephalosporins and penicillins. Give without regards to meals. If GI upset occurs give with food or milk. Avoid crushing tablets due to bitter taste. Suspension must be given with food. Intramuscular injections must be administered deep IM to minimize discomfort. Assess mouth for white patches on mucous membranes and tongue. Monitor bowel activity and stool consistency carefully. Mild GI effects may be tolerable but increasing severity may indicate onset of antibiotic-associated colitis. Monitor input and output and renal function reports for nephrotoxicity. Be alert for superinfection: severe genital or anal pruritus, abdominal pain, severe mouth soreness, moderate to severe diarrhea.

Generic Name: Ketorolac Brand Name: Toradol Dosage: 30mg/amp1 amp IM Route: IVTT x 6 Indication: Used for treating inflammationand pain inthe operation site Contraindication/Adverse Reaction: y Hypersensitivity y Cross-sensitivity with other NSAIDs may existPre- or perioperative use y Known alcohol intoleranceUse cautiously in: 1) History of GI bleeding

2) Renal impair-ment (dosage reduction may be required) 3) Cardiovascular disease (Adverse)Rash, Ringing in the ears, Headaches, Dizziness, Drowsiness, Abdominal pain, Nausea, Diarrhea Constipation, Heartburn, Fluidretention Nursing Consideration: y y y y y y Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy. Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes (chills,fever,muscles aches, pain) occur. Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.

Generic Name: Tramadol Brand Name: Amaryll, Cetodol, Clomadol, Dolcet, Dolmal, Dolotral, Dolpaz, Doltrahex, Gesidol, Mardol, Microdol, Milador, Mosepan, Pengesic, Peptrad, Plazadol, Siverol, Tracaine, Tradomal, Tradonal, Tramadin, Tramal, Tramid, Tramkor, Tramundin, Unitral, Vistra, and Vitral. Dosage and Route: Moderate to Moderately Severe Pain PO: ADULTS, ELDERLY: 50-100mg every 4-6 hours. Maximum <75 years old: 400mg per day. Maximum >75 years old: 300mg per day. Renal Function Impairment (Creatinine clearance <30mL per minute) Alert: Dialysis patients can receive their regular dose on day of dialysis. PO: ADULTS, ELDERLY: Increase dosing interval to 12 hours. Maximum daily dose: 200mg. Hepatic Function Impairment PO: ADULTS, ELDERLY: 50mg every 12 hours. Indication: Tramadol is used to treat moderate to moderately sever pain. Contraindication/Adverse Reaction:

Hypersensitivity totramadol, opioids, or any component of theformulation; opioid-dependent patients;acute intoxicationwith alcohol,hypnotics, centrally-acting analgesics,opioids, or psychotropic drugs
Adverse: Respiratory depression, Seizures, Prolonged duration of action and cumulative effect may occur in patients with impaired hepatic or renal function. Nursing Consideration: y y y Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration. Assess BP & RR before and periodically during administration. Respiratory depression has not occurred with recommended doses. Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects.

y y

Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms. Prolonged use may lead to physical and psychological dependence and tolerance, although these may be milder than with opioids. This should not prevent patient from receiving adequate analgesia. Most patients who receive tramadol for pain d not develop psychological dependence. If tolerance develops, changing to an opioid agonist may be required to relieve pain. Tramadol is considered to provide more analgesia than codeine 60 mg but less than combined aspirin 650mg/codeine 60 mg for acute postoperative pain. Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or Mao inhibitors), opioid analgesics, or other durgs that decrese the seizure threshold. Overdose may cause respiratory depression and seizures. Naloxone (Narcan) may reverse some, but not all, of the symptoms of overdose. Treatment should be symptomatic and supportive. Maintain adequate respiratory exchange. Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.

Generic Name: Ranitidine Brand Name: Zantac Dosage: 20 mg Route: IV q8h Indication: Treatment and prevention of heartburn, acid indigestion, and sour stomach. Contraindication/Adverse Reaction: Contraindicated in: Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Use Cautiously in: Renal impair- ment Geriatric patients (moresusceptible to adverse CNS reactions) Pregnancy or Lactation ADVERSE EFFECTS CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis

Nursing Consideration: y Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. y Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. y Inform patient that it may cause drowsiness or dizziness. y Inform patient that increased fluid and fiber intake may minimize constipation. y Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly. y Inform patient that medication may temporarily cause stools and tongue to appear gray black. Generic Name: Metoclopramide Brand Name: Maxolon Dosage: 1 ampq 8 hrs Route: IV Indication: y Disturbances of GI motility y Relief of symptoms of acute andrecurrentdiabeticgastroparesis y Nausea andvomiting y Metabolicdiseases y Short-termtherapy for adults withsymptomaticgastroesophageal reflux whofail to respondto conventional therapy. y Prophylaxis of postoperativenausea andvomiting whennasogastric Contraindication/Adverse Reaction: Contraindicated withallergy to metoclopramideGI hemorrhageMechanical obstruction or perforationEpilepsyUse cautiously with previously detected breastcancer, lactation, pregnancy, fluid overload,renal impairment (Adverse)CNS:restlessness,drowsiness,fatigue,insomnia,dizziness,anxietyCV:transienthypertensionGI: nauseaand diarrhea Nursing Consideration: Assessment:1. History: allergy tometoclopramide, GIhemorrhage,mechanicalobstruction or perforation,depression, epilepsy,lactation, previouslydetected breast cancer 2. Physical:orientation, reflexes,affect, bowel sounds,normal output, EEG Interventions:1. Monitor BPcarefully during IVadministration.2. Monitor diabetic patients, arrange for alterations in insulindose or timing if diabetic control iscompromised byalterations in timingof food absorption.

Generic Name: Co amoxiclav Brand Name: Amoclav Dosage and Route: Adult Dosage ( >12 years. )
Doses vary according to indication. Use 1g/dose in severe infections. To minimize potential gastrointestinal intolerance and to optimize absorption of drug, administer at the start of a meal

375.000 to 652.000 mg

510 (513.5)

8 hourly

PO

Indication: Lower resp tract infections, otitis media, sinusitis,skin & soft tissue infections, UTI, pre& postsurgical procedures, bone & joint, O & Ginfections, dentalinfections Contraindication/Adverse Reaction: History of penicillin hypersensitivity.Superinfections involvingPseudomonas or candida. Pregnancy& lactation Adverse: Allergic reactions- itching, rashes, fever - angioneuroticoedema- anaphylaxis (1 in 50,000to 100,000)Cross-allergy with other penicillinsPartial cross-allergy withcephalosporins (10%)Hepatitis, cholestatic jaundiceErythema multiforme(including Stevens-Johnson)Toxic epidermalnecrolysis; exfoliativedermatitisDiarrhea, vomitingRashes Neutropenia Anaemia Nursing Consideration: Pregnancy History of hypersensitivityRenal impairmentHepatic impairment - maycause cholestatic jaundiceup to 6 weeks after cessation May cause maculopapular rashes - almost always in presence of glandular fever