Drug Study Nursing

8/12/2019 Drug Study Nursing

1/27

Classifications Mechanism ofAction

Indication Contraindication Side Effects Nursing Considerations

Generic Name:amikacin sulfateBrand Name:Amikin

Anti-infective;Aminoglycoside

Semisynthetic

derivative ofkanamycin withbroad range ofantimicrobialactivity that

includes manystrains resistantto otheraminoglycosides

!harmacologic

"ro"erties areessentially thesame as thoseof gentamicin

A""ears toinhibit "roteinsynthesis inbacterial celland is usuallybactericidal

!rimarily for

short-termtreatment ofseriousinfections ofres"iratory

tract# bones#$oints# skin#and softtissue# CNS%includingmeningitis"eritonitisburns#recurrenturinary tractinfections%'(Is&

Unlabeled

Uses:Intrathecal orintraventricularadministration#in con$unctionwith IM or I)dosage

*istory of

hy"ersensitivity or to+icreaction withanaminoglycosid

e antibiotic

Safety during

"regnancy%category Clactation#neonates andinfants# or use"eriode+ceeding ,years old isnot

established

Adverse Effects(1%)

CNS:

Neuroto+icity.drowsiness#

unsteady gait#weakness#clumsiness#"aresthesias#tremors#convulsions#"eri"heralneuritis

S"ecial

Senses.Auditory/ototo+icity#

high-fre0uencyhearing loss#com"letehearing loss%occasionally"ermanent&;tinnitus; ringingor bu11ing inears;

Vestibular:

di11iness#

ata+ia

GI:Nausea#

vomiting#he"atoto+icity

etab!lic:

*y"okalemia#hy"omagnesemia

S"in:Skin

rash# urticaria#"ruritus#

Assessment & Drug Effects

Baseline tests:2efore

initial dose# C3S; renalfunction andvestibulocochlear nerve

function Monitor "eak and trough

amikacin blood levels. 4rawblood , h after IM orimmediately aftercom"letion of I) infusion;draw trough levelsimmediately before the ne+tIM or I) dose

#ab tests:!eriodic

serum creatinine and 2'N#

com"lete urinalysis 5ithtreatment over ,6 d# dailytests of renal function#weekly audiograms# andvestibular tests are stronglyadvised

Monitor serum

creatinine or creatinineclearance levels areassociated with to+icity

Monitor S3S ofototo+icity %"rimarilyinvolves the cochlear%auditory& branch; high-fre0uency deafness usuallya""ears first and can bedetected only byaudiometer&; indicators ofdeclining renal function;res"iratory tract infectionsand other sym"tomsindicative of su"erinfections

and notify "hysician should


2/27

redness

Ur!$enital:

7liguria#urinaryfre0uency#hematuria#tubular

necrosis#a1otemia

t&er.

Su"erinfections

they occur

Monitor for and re"ort

auditory sym"toms %tinnitus#roaring noises# sensation offullness in ears# hearingloss& and vestibulardisturbances %di11iness or

vertigo# nystagmus# ata+ia&

Monitor 3 re"ort any

changes in I37# oliguria#hematuria# or cloudy urine8ee"ing "atient wellhydrated reduces risk ofne"hroto+icity; consult"hysician regardingo"timum fluid intake

Patient & Family Education

9e"ort immediately any

changes in hearing orune+"lained ringing:roaringnoises or di11iness# and"roblems with balance orcoordination

4o not breast feed while

taking this drug withoutconsulting "hysician

Generic Name:citicoline sodiumBrand Name:yna"se#Soma1ina#Cholinerv

CNS Stimulant#!eri"heral)asodilators#CerebralActivators#Nootro"ics

Citicoline

increases bloodflow and 7I.

Consti"ation;diarrhea# drymouth;salivation;nausea;

anore+ia;vomiting;difficulty inswallowing;gastricdisorders;elevations ofblood en1ymesF?4*#alkaline "hos"hatase# AS(#A?(; he"aticim"airment;$aundice

>'.

Incontinence#urinaryretention#changes inlibido#menstrualirregularities

*ematologic.

4ecreased hematocrit#blood dyscrasias

7ther. !hlebitis

and thrombosisat I) in$ectionsites# hiccu"s#fever#dia"horesis# "aresthesias#

muscular

alert I4 indicating thatthey are e"ile"ticstaking this medication

4iscuss risk of fetal

abnormalities with"atients desiring tobecome "regnant

eac&in$ *!ints

(ake this drug e+actly

as "rescribed 4o notsto" taking this drug%long-term thera"y#antie"ile"tic thera"y&without consulting yourhealth care "rovider

Caregiver should learn

to assess sei1ures#

administer rectal form#and monitor "atient

'se of barrier

contrace"tives isadvised while using thisdrug; if you become orwish to become"regnant# consult withyour health care"rovider

It is advisable to wear amedical alert I4indicating yourdiagnosis and treatment%as antie"ile"tic&

Gou may e+"erience

these side effects.4rowsiness# di11iness%may lessen; avoiddriving or engaging inother dangerous

activities&; >I u"set%take drug with food&;


6/27

disturbances# gynecomastia;"ain# burning#and rednessafter IMin$ection

dreams# difficultyconcentrating# fatigue#nervousness# crying%reversible&

Generic Name:!aracetamBrand Name:Nootro"il

Neuromascularagent

Cerebralinsufficiency andchronicmanifestation ofC)A# "osttraumaticsyndromes# severe mentalcloudiness andvascular coma of atraumatic ofto+icorigin# chronicalcoholism and

addiction# "re-delirium# chronicvertigo of"eri"heral orcentral origin#"ediatric thera"yeg dysle+ia inchildren#involutionalsyndromes relatedto aging# corticalmyoclonus

(reatment ofthe elderly w:some degreeof cerebralfunctionalim"airment egloss ofmemory# lackofconcentrationor alertness 3vertigo

!atients

suffering frommyoclonus ofcortical origin#irres"ective ofetiology 3should beused incombinationw: otherantimyoclonic

thera"ies

Cerebralhemmorhage#end stage renaldisease

*y"erkinesia#weight gain#asthenia#nervousness#agitation#irritability#an+iety andslee"disturbances#fatigue ordrowsiness# >Idisturbances

!nit!r &eart rate+ ECGand B, *eri!dicall-t&r!u$&!ut t&e t&era*-.

/ru$ &as str!n$ taste.

i0in$ !ral f!rm it&!ran$e 2uice mas" t&etaste.

Assess *atient t! clear

aira-

,r!vide su**!rtventilati!n+ if it is needed.

Assess and su**!rt

cardiac functi!n.

eassure *atient t&at

c!mmunicati!n abilitiesill return as t&emedicati!nears !ff.

Generic Name:levetiracetaBrand Name:8e""ra

Anti-sei1ure%antie"ile"tic&drug

(he "recisemechanism%s& bywhich levetiracetame+erts itsantie"ile"tic effectis unknown (heantie"ile"tic activityof levetiracetamwas assessed in anumber of animalmodels of e"ile"tic

sei1ures?evetiracetam did

8E!!9A

in$ection is analternative foradult "atients%,H years andolder& whenoraladministrationis tem"orarilynot feasible

(he only

"atients forwhom 8e""raiscontraindicated are thosewho areallergic to8e""ra or anyof its inactiveingredients

Common side

effectsassociated withlevetiracetamincludeheadache#slee"iness#weakness#di11iness# andinfection4ifficulty

walking ormoving#

Assessment

History:*y"ersensitivity tolevetiracetam; lactation# renalim"airmentPhysical:2ody weight; bodytem"erature; skin color# lesions;orientation# affect# refle+es; !#9# adventitious sounds; bowelsounds# normal out"ut# renal

function tests
http://www.mims.com.ph/Malaysia/diagnoses/info/2510?q=vertigohttp://www.mims.com.ph/Malaysia/diagnoses/info/1561?q=myoclonushttp://www.medicinenet.com/headache/article.htmhttp://www.medicinenet.com/weakness/symptoms.htmhttp://www.mims.com.ph/Malaysia/diagnoses/info/2510?q=vertigohttp://www.mims.com.ph/Malaysia/diagnoses/info/1561?q=myoclonushttp://www.medicinenet.com/headache/article.htmhttp://www.medicinenet.com/weakness/symptoms.htm


7/27

not inhibit singlesei1ures inducedby ma+imalstimulation withelectrical current ordifferentchemoconvulsantsand showed only

minimal activity insubma+imalstimulation and inthreshold tests!rotection wasobserved# however#against secondarilygenerali1ed activityfromfocalsei1uresinduced by"ilocar"ine andkainic acid# twochemoconvulsantsthat inducesei1ures that mimicsome features ofhuman com"le+"artial sei1ures withsecondarygenerali1ation?evetiracetam alsodis"layed inhibitory"ro"erties in thekindling model inrats# another modelof human com"le+"artial sei1ures#both during kindlingdevelo"ment and inthe fully kindledstate (he"redictive value ofthese animalmodels for s"ecificty"es of humane"ile"sy isuncertain

,artial nsetSei3ures

8E!!9A is

indicated asad$unctivethera"y in thetreatment of"artial onsetsei1ures inadults withe"ile"sy

-!cl!nicSei3ures in,atients

it&4uvenile-!cl!nicE*ile*s-

8E!!9A is

indicated asad$unctivethera"y in thetreatment of

myoclonicsei1ures inadults with$uvenilemyoclonice"ile"sy

,rimar-Generali3ed!nic5Cl!nic

Sei3ures

2ecause it is

mostlye+creted bythe kidneys#caution shouldbe e+ercisedwhen"rescribing

8e""ra for"atients withrenaldysfunction

hostility#irritability#mood swings#an+iety#hallucinations#and delusionsalso have beenassociated with

levetiracetamA smallnumber of"atients maye+"erience adecrease in redor white bloodcell counts?ike otherantisei1uremedications#levetiracetamshould not bediscontinuedsuddenlybecause of therisk ofincreasedsei1ure activity

Im*lementati!n

>ive drug with food to

"revent >I u"set

Establish safety

"recautions if CNS#vision# coordination

changes occur%siderails# accom"any"atient whenambulating# etc&

Advise the use of barrier

contrace"tives while thisdrug is being used

7ffer su""ort and

encouragement fordealing with e"ile"sy

and adverse drugeffects; arrange forconsultation withsu""ort grou"s fore"ile"tics as needed

/ru$5s*ecific teac&in$ *!ints

(ake this drug e+actly

as "rescribed

4o not discontinue this

drug abru"tly or changedosage# e+ce"t on theadvice of your"hysician

4o not take this drug if

you are "regnant or"lan to become"regnant# serious fetaleffects can occur# use ofbarrier contrace"tives isrecommended

8now that the following
http://www.rxlist.com/script/main/art.asp?articlekey=25131http://www.rxlist.com/script/main/art.asp?articlekey=3285http://www.rxlist.com/script/main/art.asp?articlekey=3285http://www.rxlist.com/script/main/art.asp?articlekey=4079http://www.medicinenet.com/anxiety/article.htmhttp://www.rxlist.com/script/main/art.asp?articlekey=25131http://www.rxlist.com/script/main/art.asp?articlekey=3285http://www.rxlist.com/script/main/art.asp?articlekey=3285http://www.rxlist.com/script/main/art.asp?articlekey=4079http://www.medicinenet.com/anxiety/article.htm


8/27

8E!!9A is

indicated asad$unctivethera"y in thetreatment of"rimarygenerali1ed

tonic-clonicsei1ures inadults withidio"athicgenerali1ede"ile"sy

side effects may occur.di11iness# blurred vision%avoid driving a car or"erforming other tasksre0uiring alertness orvisual acuity if thisoccurs&; >I u"set%taking the drug with

food or milk and eatingfre0uent small mealsmay hel"&; headache#nervousness# insomnia%if these becomesevere# consult withyour health care"rovider&; fatigue%"eriodic rest "eriodsmay be hel"ful&

5ear a medical alert tag

at all times so that anyemergency medical"ersonnel taking care ofyou will know that youare an e"ile"tic "atienttaking antie"ile"ticmedication

9e"ort. severe

headache#slee"walking# skin rash#severe vomiting# chills#

fever# difficultybreathing

Generic Name:ome"ra1oleBrand Name:!rilosec# ?osec

>astrointestinalagent; "roton"um" inhibitor

An

antisecretorycom"ound thatis a gastric acid"um" inhibitor

Su""resses

gastric acidsecretion byinhibiting the*# 8-A(!ase

en1yme system@the acid

4uodenal and

gastric ulcer

>astroeso"ha

geal reflu+diseaseincludingsevere erosiveeso"hagitis %to J wk

?ong-term use

forgastroeso"hageal reflu+disease#duodenalulcers;lactation

CNS:*eadach

e# di11iness#fatigueGI:4iarrhea#abdominal"ain# nausea#mild transientincreases inliver functiontests

Ur!$enital:*ematuria#

Assessment 6 /ru$ Effects

?ab tests. Monitor

urinalysis for hematuriaand "roteinuria !eriodicliver function tests with"rolonged use

,atient 6 7amil- Educati!n
http://www.rxlist.com/script/main/art.asp?articlekey=3892http://www.rxlist.com/script/main/art.asp?articlekey=3892


9/27

%"roton *&"um"B in the"arietal cells

treatment&

?ong-term

treatment of"athologichy"ersecretory conditionssuch as

ollinger-Ellisonsyndrome#multi"leendocrineadenomas#and systemicmastocytosis

In combination

withclarithromycin

to treatduodenalulcersassociatedwith*elicobacter"ylori

"roteinuriaS"in:9ash

9e"ort any changes in

urinary elimination suchas "ain or discomfortassociated withurination# or blood inurine

9e"ort severe diarrhea;

drug may need to be

discontinued


taking this drug

Generic Name:montelukastBrand Name:Singulair

Antasthmatic?eukotrienerece"torantagonist

Selectively and

com"etitivelyblocks therece"tor thatinhibits

leukotrieneformation# thus

blocking many

of the signsand sym"tomsofasthmaKuI. Nausea#

diarrhea#abdominal"ain# dental"ain

9es"iratory.

Influen1a# cold#nasalcongestion

7ther.

>enerali1ed"ain# fever#

Assessment

*istory. *y"ersensitivity to

montelukast or any of itscom"onents; acute asthmaattacks; status asthmaticus#"regnancy and lactation

!hysical. (; orientation#

refle+es; 9# adventitioussounds; >I evaluation

Interventions

Administer in the evening


10/27

leukocyteadhesion#increasedca"illary

"ermeability#

and smoothmusclecontraction

(hese actionscontribute toinflammation#

edema# mucus

secretion# andbronchoconstrictionassociated withthe signs andsym"toms

of asthma

ato"icdermatitis

rash# fatigue without regard to food

Ensure that drug is taken

continually for o"timal effect

4o not administer for acute

asthma attack or acutebronchos"asm

Avoid the use of as"irin or

NSAI4s in "atients withknown sensitivities whilethey are using this drug

Ensure that "atient has a

readily available rescuemedication for acute asthmaattacks or situations when ashort-acting inhaled agent isneeded

(eaching "oints

(ake this drug regularly as

"rescribed; do not sto"taking this drug duringsym"tom-free "eriods; donot sto" taking this drugwithout consulting yourhealth care "roviderContinue taking any otherantiasthma drugs that havebeen "rescribed for youNotify your health care

"rovider if your asthma


11/27

becomes worse

4o not take this drug for an

acute asthma attack oracute bronchos"asm; thisdrug

is not a bronchodilator# androutine emergency"rocedures should befollowed during acuteattacks

Avoid the use of as"irin or

NSAI4s if you have a knownsensitivity to these drugsMontelukast will not "reventreactions

(hese side effects may

occur. 4i11iness %usecaution when driving or"erforming activities thatre0uire alertness if theseeffects occur&; nausea#vomiting %eat fre0uent smallmeals# take drug with food&;

headache %analgesics maybe available&

9e"ort fever# acute asthma

attacks# flulike sym"toms#lethargy

Generic Name:lactuloseBrand Name:Chronulac#Movela+# ?ilac

>astrointestinalagent;hy"erosmoticla+ative

9educes blood

ammonia;a""ears to

involvemetabolism of

!revention

and treatment

of "ortal-systemic

Since

?actulose

solutioncontains

>I.=latulence#b

orborygmi#belching#abdominal

cram"s#"ain#and distention


In children if the initial dose

causes diarrhea# dosage isreduced immediately


12/27

lactose toorganic acidsby residentintestinalbacteria

ence"halo"athy %!SEincludingstages ofhe"atic"recoma andcoma# and by

"rescri"tionfor relief ofchronicconsti"ation

galactose%less than ,Hg:, m? it iscontraindicated in "atientswho re0uire alow galactose

diet

%initialdose&;diarrhea%e+cessivedose&; nausea#vomiting# colonaccumulationof hydrogengas;hy"ernatremia

4iscontinue if diarrhea"ersists

!romote fluid intake

%L,66/


13/27


taking this drug withoutconsulting "hysician

Ensure )6H42 -=at:carbohydrat

es:"roteins:minerals:vitamins#combinations ;'sed as generalnutrients

Situations

where the"atientOs dietre0uiressu""lementation or whereconditions"recludenormal foodintake egconvalescence# early oruncom"licatedcarcinoma#coma# "re-o""re"# "ost-o"care# bowel"re"#"sychological"roblems %ieanore+ianervosa#severede"ressionmoderate

"rotein-caloricmalnutrition#nutritionalsu""ort ofchronically illor elderly"atients

Generic Name:chlore+idinegluconate

!rovides

antimicrobialeffect against awide range ofmicroorganisms

Surgical

scrub; skincleanser;

"reo"erativeskin

>astric

distress#alcohol

into+ication

/ermat!l!$ic

Irritation;dermatitis;

Inform "atient that staining

of teeth# dental work# tongueand oral tissue may occurStaining does not adverselyaffect health and can usuallybe removed by "rofessional


14/27

"re"aration;

skin wound

cleanser;

hand rinse;

oral rinse for

gingivitis;

an ad$unct to

scaling androot "lanning"rocedures forreduction of"ocket de"thin adults with"eriodontitis;

as ahydro"hilicwounddressing thatis used toabsorbe+udate andcover a woundcaused by theuse ofvascular andnon-vascular

"ercutaneousmedicaldevices% 2io"atchonly&

"hotosensitivity; sensiti1ationandgenerali1edallergicreactions#es"ecially ingenital area

EEN(

4eafness;

transient"arotitis;altered taste"erce"tion

iscellane!us

Staining of

teeth and oralsurfaces;increasedcalculus

formation;minor irritationand su"erficialdes0uamationof oral mucosa

techni0ues

Caution "atient that taste

"erce"tion may be alteredduring treatment; "ermanenttaste alteration has not beennoted

Inform "atient that oral rinse

contains alcohol

Instruct "atient to avoid

having medication come intocontact with ears and eyes#which could cause"ermanent damage

Instruct "atient not to

swallow "roduct but toe+"ectorate after oralrinsing

Advise "atient to avoid

eating < to h aftertreatment

Advise "atients to avoid

dental floss at the site ofchi" insertion for ,6 daysafter "lacement becauseflossing might dislodge thechi"

Instruct "atient to notifydentist "rom"tly if chi"dislodges

Advise "atient that although

mild to moderate sensitivityis normal during the firstweek after "lacement of thechi"# notify dentist if "ain#swelling# or other "roblemsoccur

Brand Name:

ME27

(o"ical

!re"arations

!roviding an

o"timum

ME27 has

been used

ME27 is of "ure

herbal edible

!atients will be randomised


15/27

"hysiologicalmoisturenecessary forregenerationand re"air

Inducing an

anti-inflammatory

effect# therebyreducingedema anderythema

Creating an

atmos"hereunfavorable forbacterial andfungalcoloni1ation

Isolating and

"rotecting

e+"osed andin$ured nerveendings"roducingthereby ananalgesiceffect

!roviding local

nutrition forwound bedcells

?i0uefying the

necrotic tissue Isolating and

"rotecting thewound bedfromenvironmentalfactors but atthe same timemaintainingdrainage andgaseouse+change

9educing body

succesfully inthe treatmentof thefollowingwounds.

=irst degree

burns# where

the "ain reliefand the fasthealing areremarkable#eg sunburn

Second

degree burns#su"erficial anddee" If"ro"erlya""lied# no

skin grating isneeded andregenerationtakes "lacefrom hairfollicles andglands in thedermis andsubcutaneoustissue

(hird

degree burns#to isolate thewounds#reduce "ain#and e+"editenon-surgicaldebridementof the necrotictissue to"re"are thewound forgrafting

origin No sideeffects to the"roduct have beenre"orted so far#e+"ect for rareallergic reactions tosesame oil

to receive either.

, Moist e+"osed burn

ointment %ME27 a""liedtwice "er day with theassistance of nursing staff


16/27

fluids loss fromdamaged skin%burns&

Asborbing

residual heat inacute burnwounds

E+"editing

e"itheliali1ationwithe+ce"tionallyacce"tablecosmesis

4onor site#

to decrease"ain# controlinfection# ande+"editehealing%average of days has been

re"orted&

Chronic

woundsincluding bedulcers#diabetic food#and leg ulcers

!ost laster

resurfacing#chemical

"eeling# anddermabrasion

Surgical

woundsincludingobstetricalwounds

5ound of

circumcision

Mucous

membranewounds suchas buccalulcers

Cracked

heels andcrackedni""les

Generic Name:albuterol sulfate

2ronchodilator%thera"eutic&;

In low doses#

acts relatively

9elief and

"revention of

Contraindicate

d with

CNS.9estlessness#

Assessment


17/27

Brand Name:Salbutamol

adrenergics%"harmacologic&

selectively atbetaI. Nausea#

vomiting#heartburn#

unusual or badtaste in mouth

>'. Increased

incidence ofleiomyomas ofuterus whengiven in higherthan humandoses in

"reclinical


albuterol; tachyarrhythmias#tachycardia caused bydigitalis into+ication; generalanesthesia with halogenatedhydrocarbons orcyclo"ro"ane; unstablevasomotor system

disorders; hy"ertension;coronary insufficiency# CA4;history of stroke; C7!4"atients who havedevelo"ed degenerativeheart disease; diabetesmellitus; hy"erthyroidism;history of sei1ure disorders;"sychoneurotic individuals;lactation

!hysical. 5eight; skin color#

(# turgor; orientation#refle+es# affect; !# 2!; 9#adventitious sounds; bloodand urine glucose# serumelectrolytes# thyroid functiontests# EC>

Interventi!ns

'se minimal doses for

minimal "eriods; drugtolerance can occur with"rolonged use

Maintain a beta-adrenergic

blocker %cardioselective


18/27

c individuals;labor anddelivery %oraluse hasdelayedsecond stageof labor;"arenteral useof beta


19/27

nausea# vomiting# change intaste %eat fre0uent smallmeals&; ra"id heart rate#an+iety# sweating# flushing#insomnia

9e"ort chest "ain#di11iness# insomnia#weakness# tremors orirregular heartbeat# difficultybreathing# "roductive cough#failure to res"ond to usualdosage

Generic Name:!henytoinBrand Name:4ilantin Infatabs

Central nervoussystem agent;anticonvulsant;hydantoin

Mechanism of

action is stillunknown Ahydantoinderivative that

"robablystabili1esneuronalmembranesand limitssei1ure activityby eitherincreasingreflu+ ordecreasinginflu+ of sodiumions across cell

membranes inthe motorcorte+ duringgeneration ofnerve im"ulses

Control of

tonic-clonic%grandma&and com"le+"artial

%(em"orallobe& sei1ures

=or "atient

re0uiring aloading dose

!revention

and treatmentof sei1uresoccurringduringneurosurgery

Status

E"ile"ticus

Contraindicate

d in "atienthy"ersensitiveto hydantoin

and those withsinusbradycardia#SA block#second orthird degreeA) block orAdams-Strokessyndrome

CNS. ata+ia#

slurred s"eech#di11iness#insomnia#nervousness#

twitching#headache#mentalconfusion#decreasedcoordination

C). "eriateritis

nodosa

EEN(.

nystagmus#di"lo"ia#blurred vision

>I. gingival

hy"er"lasia#nausea#

vomiting#consti"ation

7bserve ten rights in giving

medication

'se cautiously in "atients

with he"atic dysfunction#hy"otension# myocardialinfraction# diabetes# orres"iratory de"ression# inelderly or debilitated"atients and in thosereceiving other hydantoinderivatives

Elderly "atients tend tometaboli1e "henytoin slowlyand may need reduceddosages

!henytoin re0uirements

usually increase during"regnancy

Sto" drug if rash a""ears


20/27

*ematologic.

thrombocyto"enia#leuko"enia#megaloblasticanemia#agrunolocytosi

s

*e"atic. to+ic

he"atitis

Metabolic.

hy"erglycemia

Muscuskeletal.osteomalacia

Skin. "ur"uric

dermatitis#"hotosensitivityreactions#necrosis#inflammation atin$ection site#

discoloration ofskin if given byI) "ush in backof hand

7ther.

hirsutism#lym"hadeno"athy

'se only clear solution for

in$ection A slight yellowcolor is acce"table 4onPtrefrigerate

4onPt give IM unless

dosage ad$ustments aremade; drug may "reci"itateat in$ection site# cause "ain#and be absorbed erratically

4ivided doses given with or

after meals may decreaseadverse >I reactions

Advise "atient to avoid

alcohol

5arm "atient not to sto"

drug abru"tly becausesei1ures may worsen

Stress im"ortance of good

oral hygiene and regulardental e+aminations

Caution "atient that drug

may have color "ink# red# orreddish brown urine

Generic Name:a1ithromycin

Brand Name:

Macrolideantibiotic

(reatment of

?9Is. Acutebacterial

Contraindicate

d withhy"ersensitivit

CNS.

4i11iness#headache#

Assessment



21/27

ithroma+ e+acerbationsof C7!4 dueto *influen1ae#Mora+ellacatarrhalis# S"neumoniae;community-ac0uired"neumoniadue to S"neumoniae#* influen1ae

(reatment of

?9Is.Stre"tococcal"haryngitisand tonsillitisdue to

Stre"tococcus"yogenes inthose whocannot take"enicillins

(reatment of

uncom"licatedskin infectionsdue toSta"hylococcus aureus# S

"yogenes#Stre"tococcusagalactiae

(reatment of

nongonococcal urethritis andcervicitis dueto Ctrachomatis;treatment of!I4

y toa1ithromycin#erythromycin#or anymacrolideantibiotic

'se

cautiously withgonorrhea orsy"hilis#"seudomembranous colitis#he"atic orrenalim"airment#lactation

vertigo#somnolence#fatigue

>I. 4iarrhea#

abdominal"ain# nausea#dys"e"sia#flatulence#vomiting#melena#"seudomembranous colitis

7ther.

Su"erinfections# angioedema#rash#"hotosensitivity# vaginitis

a1ithromycin# erythromycin#or any macrolide antibiotic;gonorrhea or sy"hilis#"seudomembranous colitis#he"atic or renal im"airment#lactation

!hysical. Site of infection;

skin color# lesions;orientation# >I out"ut# bowelsounds# liver evaluation;culture and sensitivity testsof infection# urinalysis# liverand renal function tests

Interventi!ns

Culture site of infection

before thera"y

Administer on an em"ty

stomach , hr before or I u"set occurs


22/27

(reatment of

acute sinusitis

(reatment of

otitis mediacaused by *influen1ae# Mcatarrhalis# S

"neumoniaein children L Hmo

(reatment of

"haryngitisand tonsillitisin children L lucocorticoid

Enters target cellsand binds tocyto"lasmicrece"tor; initiatesmany com"le+reactions that areres"onsible for itsanti-inflammatory#immunosu""ressive %glucocorticoidand salt-retaining%mineralocorticoid&actions Some

actions maybe

9e"lacement

thera"y inadrenalcorticalinsufficiency

5 Aller$ic states8

Severe or

inca"acitatingallergicconditions-

*ematologicdi

C!ncentrati!ns

Allergy to any

com"onent ofthe drug-

=ungal

infections

Amebiasis

*e"atitis 2

)accinia or

varicella

Antibiotic-

resistant

infections


Establish baseline and

continuing data on 2!#weight# fluid and electrolytebalance# and blood glucose

?ab tests. !eriodic serum

electrolytes blood glucose#*ct and *gb# "latelet count#


23/27

undesirable#de"ending on druguse

sorders-'lcerativecolitis

Immunosu""r

ession

,recauti!n

8idney

disease

?iver disease

Cirrhosis

*y"othyroidism

'lcerative

colitis withim"ending"erforation

4iverticulitis

9ecent >I

surgery

Active or

latent "e"ticulcer

Inflammatory

bowel disease

*y"ertension

*eart failure

(hromboembolic tendencies

7steo"orosis

Convulsive

disorders

Metastatic

carcinoma

4iabetesmellitus

(uberculosis

?actation

and 52C with differential

Monitor for adverse effects

7lder adults and "atientswith low serum albumin arees"ecially susce"tible to

adverse effects

2e alert to signs of

hy"ocalcemia

7"hthalmosco"ic

e+aminations are

recommended every


24/27

2e alert to "ossibility of

masked infection anddelayed healing%antiinflammatory andimmunosu""ressive

actions&

Note: Dose adjustment maybe required if patient issubjected to severe stress(serious infection, surgery, orinjury)

Note: !ingle doses ofcorticosteroids or use for a shortperiod ("# $%) do not produce$ithdra$al symptoms $hen

discontinued, even $ithmoderately large doses

,atient 6 7amil- Educati!n

E+"ect a slight weight gain

with im"roved a""etite Afterdosage is stabili1ed# notify"hysician of a sudden slowbut steady weight increase@< kg % lb&:wkB

Avoid alcohol and caffeine;

may contribute to steroid-ulcer develo"ment in long-term thera"y

4o not ignore dys"e"sia

with hy"eracidity 9e"ortsym"toms to "hysician and


25/27

do N7( self-medicate tofind relief

4o N7( use as"irin or other

7(C drugs unless"rescribed s"ecifically by

the "hysician

Note: & high protein, calcium,and vitamin D diet is advisableto reduce ris% of corticosteroid'induced osteoporosis

Notify "hysician of slow

healing# any vague feelingof being sick# or return to"retreatment sym"toms

4o not abru"tly discontinue

drug; doses are graduallyreduced to "reventwithdrawal sym"toms

9e"ort e+acerbation of

disease during drugwithdrawal

Carry medical identification

at all times It needs toindicate medical diagnosis#drug thera"y# and name of"hysician


26/27

A""ly to"ical "re"arations

s"aringly in small children(he ha1ard of systemicto+icity is higher because ofthe greater ratio of skinsurface area to body weight

Check shelf-life date on

to"ical corticosterone duringlong-term use


taking:using this drugwithout consulting "hysician

Generic Name:Amino AcidsBrand Name:(ravasol

,6D (ravasol%Amino Acid&In$ectionadministered viacentral vein will"rovide biologicallyutili1able sourcematerial for "roteinsynthesis whenused withconcentratedcalorie sources%such as hy"ertonicde+trose or fatemulsionelectrolytes#vitamins# andmineralsAdministered"eri"herally aftera""ro"riate dilutionor with minimalcaloriesu""lementation%such as Dde+trose it

enhances the

D andJD(ravasolQ%Amino Acid&In$ections areindicated asan ad$unct inthe offsettingof nitrogenloss or in thetreatment ofnegative

nitrogenbalance in"atientswhere. %,& thealimentarytract cannot orshould not beused# %


27/27

conservation ofbody "rotein for "rotein are

substantiallyincreased# aswith e+tensiveburns

mia#hy"erammonemia#dehydration#hy"ocalcemia

>I. Nausea#

abdominal "ain

>'. >lycosuria

osmoticdieresis

IIN(E>.

E+travasationnecrosis#"hlebitis atin$ection site

coma. asteri+is#confusion# uremic fetor#lethargy

*y"erammonemia.

nausea# vomiting#malaise# tremors#anore+ia# sei1ures

Change of dressing and

I) tubing to "reventinfection every

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