Classifications Generic Name: amikacin sulfate Brand Name: Amikin Anti-infective; Aminoglycoside

Mechanism of Action Semisynthetic derivative of kanamycin with broad range of antimicrobial activity that includes many strains resistant to other aminoglycoside s !harmacologic "ro"erties are essentially the same as those of gentamicin A""ears to inhibit "rotein synthesis in bacterial cell and is usually bactericidal

Indication !rimarily for short-term treatment of serious infections of res"iratory tract# bones# $oints# skin# and soft tissue# CNS %including meningitis&# "eritonitis burns# recurrent urinary tract infections %'(Is& Unlabeled Uses: Intrathe cal or intraventricula r administration# in con$unction with IM or I) dosage

Contraindication *istory of hy"ersensitivit y or to+ic reaction with an aminoglycosid e antibiotic Safety during "regnancy %category C&# lactation# neonates and infants# or use "eriod e+ceeding ,years old is not established

Side Effects Adverse Effects (1%) CNS: Neuroto+icity. drowsiness# unsteady gait# weakness# clumsiness# "aresthesias# tremors# convulsions# "eri"heral neuritis S"ecial Senses. Auditory/ ototo+icity# high-fre0uency hearing loss# com"lete hearing loss %occasionally "ermanent&; tinnitus; ringing or bu11ing in ears; Vestibular: di11iness# ata+ia GI: Nausea# vomiting# he"atoto+icity etab!lic: *y"okalemia# hy"omagnese mia S"in: Skin rash# urticaria# "ruritus#

Nursing Considerations Assessment & Drug Effects Baseline tests: 2efore initial dose# C3S; renal function and vestibulocochlear nerve function Monitor "eak and trough amikacin blood levels. 4raw blood , h after IM or immediately after com"letion of I) infusion; draw trough levels immediately before the ne+t IM or I) dose #ab tests: !eriodic serum creatinine and 2'N# com"lete urinalysis 5ith treatment over ,6 d# daily tests of renal function# weekly audiograms# and vestibular tests are strongly advised Monitor serum creatinine or creatinine clearance levels are associated with to+icity Monitor S3S of ototo+icity %"rimarily involves the cochlear %auditory& branch; highfre0uency deafness usually a""ears first and can be detected only by audiometer&; indicators of declining renal function; res"iratory tract infections and other sym"toms indicative of su"erinfections and notify "hysician should

redness Ur!$enital: 7liguria# urinary fre0uency# hematuria# tubular necrosis# a1otemia %t&er. Su"erinfections

they occur Monitor for and re"ort auditory sym"toms %tinnitus# roaring noises# sensation of fullness in ears# hearing loss& and vestibular disturbances %di11iness or vertigo# nystagmus# ata+ia& Monitor 3 re"ort any changes in I37# oliguria# hematuria# or cloudy urine 8ee"ing "atient well hydrated reduces risk of ne"hroto+icity; consult "hysician regarding o"timum fluid intake

Patient & Family Education 9e"ort immediately any changes in hearing or une+"lained ringing:roaring noises or di11iness# and "roblems with balance or coordination 4o not breast feed while taking this drug without consulting "hysician

Generic Name: citicoline sodium Brand Name: ;yna"se# Soma1ina# Cholinerv

CNS Stimulant# !eri"heral )asodilators# Cerebral Activators# Nootro"ics

Citicoline increases blood flow and 7< consum"tion in the brain It is also involved in the biosynthesis action

Citicoline is indicated in C)4 in acute recovery "hase in severe s:s+ of cerebrovascul ar insufficiency and in-cranial traumatism and their se0uellae

Any allergy or hy"ersensitivit y to the drug *y"ertonia of the "arasym"athe tic nervous system 'se cautiously for "regnancy and lactation

=leeting and discrete hy"otension effect# increased "arasym"atheti c effects# low blood "ressure Itching or hives# swelling in face or hands# chest

(ake Citicoline as "rescribed (ake Citicoline on time Monitor "atients neurologic status Note if there are signs of slurring of s"eech Note for adverse reactions

Citicoline in C)A# stimulates brain function

Conscious use for "atient with renal and he"atic damage

tightness# tingling in mouth and throat

(iter medication when discontinuing (each "atient on how to take the drug Arrange for regular followu"s

Generic Name: dia1e"am Brand Name: )alium

2en1odia1e"ine# An+iolytic# Antie"ile"tic# Skeletal muscle rela+ant %centrally acting&

E+act mechanisms of action not understood; Acts mainly at the limbic system and reticular formation; May act in s"inal cord and at su"ras"inal s ites to "roduce skeletal muscle rela+ation; !otentiates the effects of >A2A# an inhibitory neurotransmitte r; An+iolytic effect s occur at doses well below those necessary to cause sedation# ata+ia; *as little effect on cortical function

Management of an+iety disorders or for short-term relief of sym"toms of an+iety Acute alcohol withdrawal; may be useful in sym"tomatic relief of acute agitation# tremor# delirium tremens# hallu cinosis Muscle rela+ant. Ad$unct for relief of refle+ skeletal muscle s"asm due to local "athology %inflammation of muscles or $oints& or secondary to trauma;s"astic ity caused by u""er motor neuron disord

Contraindicate d with hy"ersen sitivity to ben1odia1e"in es; "sychoses# acute narrowangle glaucoma# shock# coma# acute alcoholic into+ication; "regnancy %cleft li" or "alate# inguinal hernia# cardiac defects# micro ce"haly# "yloric stenosi s when used in first trimester; neonatal withdrawal syndrome re"orted in newborns&; lactation 'se cautiously with elderly or debilitated

CNS. (ransient# mild drowsiness initially; sedation# de"ression# lethargy# a"athy# fatigue# lightheadedness# disorientation# restlessness# confusion#cryin g# delirium# headache# slurred s"eech# dysart hria# stu"or# rigidity# tremor# dystoni a# vertigo# eu"horia# nervousness# difficulty in concentration# vivid dreams# "sychomotor retardation# e+t ra"yramidal sy m"toms; mild "arado+ical e+citatory reactions# during first < wk of treatment#

Assessment *istory. *y"ersensitivity to ben1odia1e"ines; "sychoses# acute narrow-angle glaucoma# shock# coma# acute alcoholic into+ication; elderly or debilitated "atients; im"aired liver or renal function; "regnancy# lactation !hysical. 5eight; skin color# lesions; orientation# affect# refle+es# sensory nerve function# o"hthalmologic e+amination; !# 2!; 9# adventitious sounds; bowel sounds# normal out"ut# liver evaluation; normal out"ut; ?=(s# renal function tests# C2C

Interventi!ns 'A(NING: 4o not administer intraarterially; may "roduce arterios"asm# gangrene @:swsAredAbo+B Change from I) thera"y to oral thera"y as soon

ers %cerebral "alsy and "ara"legia&; at hetosis# stiffman syndrome !arenteral. (reatment of tetanus Antie"ile"tic. Ad$unct in status e"ile"ti cus and severe recurrent convulsive sei1ures %"arenteral&; ad$unct in sei1ure disorders %oral& !reo"erative %"arenteral&. 9elief of an+iety and tension and to lessen recall in "atients "rior to surgical "rocedures# c ardioversion# and endosco"i c "rocedures 9ectal. Management of selected# refractory "atients with e"ile"sy who re0uire

"atients; im"aired liver or renal function; and in "atients with a history of substance abuse

visual and auditory disturbances# d i"lo"ia# nystag mus# de"ressed hearing# nasal congestion C). 2radycardia# tachycardia# C) colla"se# hy"ertension and hy"otension# "al"itations# edema 4e"endence. 4rug de"endence with withdrawal syndrome when drug is discontinued %common with abru"t discontinuation of higher dosage used for longer than - mo&; I) dia1e"am. , CD incidence of fatalities; oral ben1odia1e"in es ingested alone; no welldocumented fatal overdoses 4ermatologic. 'rticaria# "rurit us# skin rash#

as "ossible 4o not use small veins %dorsum of hand or wrist& for I) in$ection 9educe dose of o"ioid analgesics with I) dia1e"am; dose should be reduced by at least one-third or eliminated Carefully monitor !# 2!# and res"iration during I) administration 'A(NING: Maintain "atients receiving "arenteral ben 1odia1e"ines in bed for E hr; do not "ermit ambulatory "atients to o"erate a vehicle following an in$ection Monitor EE> in "atients treated for status e"ile"ticus; sei1ures may recur after initial control# "resumably because of short duration of drug effect Monitor liver and renal function# C2C during long-term thera"y (a"er dosage gradually after long-term thera"y# es"ecially in e"ile"tic "atients Arrange for e"ile"tic "atients to wear medical

intermittent use to control bouts of increased sei1ure activity 'nlabeled use. (reatment of "anic attacks

dermatitis >I. Consti"ation; diarrhea# dry mouth; salivation; nausea; anore+ia; vomiting; difficulty in swallowing; gastric disorders; elevations of blood en1ymes F?4*# alkaline "hos" hatase# AS(# A?(; he"atic im"airment; $aundice >'. Incontinence# urinary retention# changes in libido# menstrual irregularities *ematologic. 4ecreased he matocrit# blood dyscrasi as 7ther. !hlebitis and thrombosis at I) in$ection sites# hiccu"s# fever# dia"horesis# "a resthesias# muscular

alert I4 indicating that they are e"ile"tics taking this medication 4iscuss risk of fetal abnormalities with "atients desiring to become "regnant

)eac&in$ *!ints (ake this drug e+actly as "rescribed 4o not sto" taking this drug %long-term thera"y# antie"ile"tic thera"y& without consulting your health care "rovider Caregiver should learn to assess sei1ures# administer rectal form# and monitor "atient 'se of barrier contrace"tives is advised while using this drug; if you become or wish to become "regnant# consult with your health care "rovider It is advisable to wear a medical alert I4 indicating your diagnosis and treatment %as antie"ile"tic& Gou may e+"erience these side effects. 4rowsiness# di11iness %may lessen; avoid driving or engaging in other dangerous activities&; >I u"set %take drug with food&;

disturbances# g ynecomastia; "ain# burning# and redness after IM in$ection

dreams# difficulty concentrating# fatigue# nervousness# crying %reversible&

Generic Name: !aracetam Brand Name: Nootro"il

Neuromascular agent

Cerebral insufficiency and chronic manifestation of C)A# "ost traumaticsyndrome s# severe mental cloudiness and vascular coma of a traumatic of to+icorigin# chronic alcoholism and addiction# "redelirium# chronic vertigo of "eri"heral or central origin# "ediatric thera"y e g dysle+ia in children#involutional syndromes related to aging# cortical myoclonus

(reatment of the elderly w: some degree of cerebral functional im"airment eg loss of memory# lack of concentration or alertness 3 vertigo !atients suffering from myoclonus of cortical origin# irres"ective of etiology 3 should be used in combination w: other antimyoclonic thera"ies

Cerebral hemmorhage# end stage renal disease

*y"erkinesia# weight gain# asthenia# nervousness# agitation# irritability# an+iety and slee" disturbances# fatigue or drowsiness# >I disturbances

!nit!r &eart rate+ ECG and B, *eri!dicallt&r!u$&!ut t&e t&era*-. /ru$ &as str!n$ taste. i0in$ !ral f!rm 1it& !ran$e 2uice mas" t&e taste. Assess *atient t! clear air1a,r!vide su**!rt ventilati!n+ if it is needed. Assess and su**!rt cardiac functi!n. (eassure *atient t&at c!mmunicati!n abilities 1ill return as t&e medicati!n1ears !ff.

Generic Name: levetiraceta Brand Name: 8e""ra

Anti-sei1ure %antie"ile"tic& drug

(he "recise mechanism%s& by which levetiracetam e+erts its antie"ile"tic effect is unknown (he antie"ile"tic activity of levetiracetam was assessed in a number of animal models of e"ile"tic sei1ures ?evetiracetam did

8E!!9A in$ection is an alternative for adult "atients %,H years and older& when oral administration is tem"orarily not feasible

(he only "atients for whom 8e""ra is contraindicate d are those who are allergic to 8e""ra or any of its inactive ingredients

Common side effects associated with levetiracetam include headache# slee"iness# weakness# di11iness# and infection 4ifficulty walking or moving#

Assessment History: *y"ersensitivity to levetiracetam; lactation# renal im"airment Physical: 2ody weight; body tem"erature; skin color# lesions; orientation# affect# refle+es; !# 9# adventitious sounds; bowel sounds# normal out"ut# renal function tests

not inhibit single sei1ures induced by ma+imal stimulation with electrical current or different chemoconvulsants and showed only minimal activity in subma+imal stimulation and in threshold tests !rotection was observed# however# against secondarily generali1ed activity from focal sei1ures induced by "ilocar"ine and kainic acid# two chemoconvulsants that induce sei1ures that mimic some features of human com"le+ "artial sei1ures with secondary generali1ation ?evetiracetam also dis"layed inhibitory "ro"erties in the kindling model in rats# another model of human com"le+ "artial sei1ures# both during kindling develo"ment and in the fully kindled state (he "redictive value of these animal models for s"ecific ty"es of human e"ile"sy is uncertain

,artial %nset Sei3ure s

8E!!9A is indicated as ad$unctive thera"y in the treatment of "artial onset sei1ures in adults with e"ile"sy -!cl!nic Sei3ure s in ,atients 1it& 4uvenile -!cl! nic E*ile*s -

2ecause it is mostly e+creted by the kidneys# caution should be e+ercised when "rescribing 8e""ra for "atients with renal dysfunction

hostility# irritability# mood swings# an+iety# hallucinations# and delusions also have been associated with levetiracetam A small number of "atients may e+"erience a decrease in red or white blood cell counts ?ike other antisei1ure medications# levetiracetam should not be discontinued suddenly because of the risk of increased sei1ure 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 when ambulating# etc & Advise the use of barrier contrace"tives while this drug is being used 7ffer su""ort and encouragement for dealing with e"ile"sy and adverse drug effects; arrange for consultation with su""ort grou"s for e"ile"tics as needed

8E!!9A is indicated as ad$unctive thera"y in the treatment of myoclonic sei1ures in adults with $uvenile myoclonic e"ile"sy

/ru$5s*ecific teac&in$ *!ints (ake this drug e+actly as "rescribed 4o not discontinue this drug abru"tly or change dosage# e+ce"t on the advice of your "hysician 4o not take this drug if you are "regnant or "lan to become "regnant# serious fetal effects can occur# use of barrier contrace"tives is recommended 8now that the following

,rimarGenerali 3ed )!nic5 Cl!nic Sei3ure s

8E!!9A is indicated as ad$unctive thera"y in the treatment of "rimary generali1ed tonic-clonic sei1ures in adults with idio"athic generali1ed e"ile"sy

side effects may occur. di11iness# blurred vision %avoid driving a car or "erforming other tasks re0uiring alertness or visual acuity if this occurs&; >I u"set %taking the drug with food or milk and eating fre0uent small meals may hel"&; headache# nervousness# insomnia %if these become severe# consult with your health care "rovider&; fatigue %"eriodic rest "eriods may be hel"ful& 5ear a medical alert tag at all times so that any emergency medical "ersonnel taking care of you will know that you are an e"ile"tic "atient taking antie"ile"tic medication

Generic Name: ome"ra1ole Brand Name: !rilosec# ?osec

>astrointestinal agent; "roton "um" inhibitor

An antisecretory com"ound that is a gastric acid "um" inhibitor Su""resses gastric acid secretion by inhibiting the *I# 8I-A(!ase en1yme system @the acid

4uodenal and gastric ulcer >astroeso"ha geal reflu+ disease including severe erosive eso"hagitis %to J wk

?ong-term use for gastroeso"ha geal reflu+ disease# duodenal ulcers; lactation

CNS:*eadach e# di11iness# fatigue GI:4iarrhea# abdominal "ain# nausea# mild transient increases in liver function tests Ur!$enital:*e maturia#

9e"ort. severe headache# slee"walking# skin rash# severe vomiting# chills# fever# difficulty breathing Assessment 6 /ru$ Effects

?ab tests. Monitor urinalysis for hematuria and "roteinuria !eriodic liver function tests with "rolonged use

,atient 6 7amil- Educati!n

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

treatment& ?ong-term treatment of "athologic hy"ersecretor y conditions such as ;ollingerEllison syndrome# multi"le endocrine adenomas# and systemic mastocytosis In combination with clarithromycin to treat duodenal ulcers associated with *elicobacter "ylori !ro"hyla+is and chronic treatment of asthma in adults and children L ,< mo 9elief of sym"toms of seasonal allergic rhinitis in adults and children L < yr 'nlabeled uses. Chronic urticaria#

"roteinuria S"in:9ash

9e"ort any changes in urinary elimination such as "ain or discomfort associated with urination# or blood in urine 9e"ort severe diarrhea; drug may need to be discontinued 4o not breast feed while taking this drug

Generic Name: montelukast Brand Name: Singulair

Antasthmatic ?eukotriene rece"tor antagonist

Selectively and com"etitively blocks the rece"tor that inhibits leukotriene formation# thus blocking many of the signs and sym"toms of asthmaKu<6,-n eutro"hil and eosino"hil migration# neutro"hil and monocyte aggregation#

Contraindicate d with hy"ersensitivit y to montelukast or any of its com"onents;a cute asthma attacks; status asthmaticus 'se cautiously with "regnancy and lactation

CNS. *eadache# di11iness >I. Nausea# diarrhea# abdominal "ain# dental "ain 9es"iratory. Influen1a# cold# nasal congestion 7ther. >enerali1ed "ain# fever#

Assessment *istory. *y"ersensitivity to montelukast or any of its com"onents; acute asthma attacks; status asthmaticus# "regnancy and lactation

!hysical. (; orientation# refle+es; 9# adventitious sounds; >I evaluation

Interventions Administer in the evening

leukocyte adhesion# increased ca"illary "ermeability# and smooth muscle contraction (hese actions contribute to inflammation# edema# mucus secretion# and bronchoconstri ction associated with the signs and sym"toms of asthma

rash# fatigue ato"ic dermatitis

without regard to food

Ensure that drug is taken continually for o"timal effect

4o not administer for acute asthma attack or acute bronchos"asm

Avoid the use of as"irin or NSAI4s in "atients with known sensitivities while they are using this drug

Ensure that "atient has a readily available rescue medication for acute asthma attacks or situations when a short-acting inhaled agent is needed

(eaching "oints (ake this drug regularly as "rescribed; do not sto" taking this drug during sym"tom-free "eriods; do not sto" taking this drug without consulting your health care "rovider Continue taking any other antiasthma drugs that have been "rescribed for you Notify your health care "rovider if your asthma

becomes worse

4o not take this drug for an acute asthma attack or acute bronchos"asm; this drug is not a bronchodilator# and routine emergency "rocedures should be followed during acute attacks

Avoid the use of as"irin or NSAI4s if you have a known sensitivity to these drugs Montelukast will not "revent reactions

(hese side effects may occur. 4i11iness %use caution when driving or "erforming activities that re0uire alertness if these effects occur&; nausea# vomiting %eat fre0uent small meals# take drug with food&; headache %analgesics may be available&

Generic Name: lactulose Brand Name: Chronulac# Movela+# ?ilac >astrointestinal agent; hy"erosmotic la+ative 9educes blood ammonia; a""ears to involve metabolism of

!revention and treatment of "ortalsystemic

Since ?actulose solution contains

>I.=latulence#b orborygmi#belc hing#abdominal cram"s#"ain#an d distention

9e"ort fever# acute asthma attacks# flulike sym"toms# lethargy Assessment 6 /ru$ Effects In children if the initial dose causes diarrhea# dosage is reduced immediately

lactose to organic acids by resident intestinal bacteria

ence"halo"at hy %!SE&# including stages of he"atic "recoma and coma# and by "rescri"tion for relief of chronic consti"ation

galactose %less than , H g:,M m?&# it is contraindicate d in "atients who re0uire a low galactose diet

%initial dose&;diarrhea %e+cessive dose&; nausea# vomiting# colon accumulation of hydrogen gas; hy"ernatremia

4iscontinue if diarrhea "ersists

!romote fluid intake %LN,M66/<666 m?:d& during drug thera"y for consti"ation; older adults often self-limit li0uids ?actulose-induced osmotic changes in the bowel su""ort intestinal water loss and "otential hy"ernatremia

4iscuss strategy with "hysician

,atient 6 7amil- Educati!n ?a+ative action is not instituted until drug reaches the colon; therefore# about <-/-J h is needed

4o not self-medicate with another la+ative due to slow onset of drug action

Notify "hysician if diarrhea %i e # more than < or E soft stools:d& "ersists more than <-/-J h 4iarrhea is a sign of overdosage 4ose ad$ustment may be indicated

 Ensure )6H42 =at:carbohydrat es:"roteins:mine rals:vitamins# combinations ; 'sed as general nutrients

4o not breast feed while taking this drug without consulting "hysician

Generic Name: chlore+idine gluconate

!rovides antimicrobial effect against a wide range of microorganism s

Situations where the "atientOs diet re0uires su""lementati on or where conditions "reclude normal food intake eg convalescenc e# early or uncom"licated carcinoma# coma# "re-o" "re"# "ost-o" care# bowel "re"# "sychological "roblems %ie anore+ia nervosa# severe de"ression&# moderate "rotein-caloric malnutrition# nutritional su""ort of chronically ill or elderly "atients Surgical scrub; skin cleanser; "reo"erative skin

/ermat!l!$ic >astric distress# alcohol into+ication

Irritation; dermatitis;

Inform "atient that staining of teeth# dental work# tongue and oral tissue may occur Staining does not adversely affect health and can usually be removed by "rofessional

"re"aration; skin wound cleanser; hand rinse; oral rinse for gingivitis; an ad$unct to scaling and root "lanning "rocedures for reduction of "ocket de"th in adults with "eriodontitis; as a hydro"hilic wound dressing that is used to absorb e+udate and cover a wound caused by the use of vascular and non-vascular "ercutaneous medical devices % 2io"atch only&

"hotosensitivity ; sensiti1ation and generali1ed allergic reactions# es"ecially in genital area EEN(

techni0ues Caution "atient that taste "erce"tion may be altered during treatment; "ermanent taste alteration has not been noted Inform "atient that oral rinse contains alcohol Instruct "atient to avoid having medication come into contact with ears and eyes# which could cause "ermanent damage Instruct "atient not to swallow "roduct but to e+"ectorate after oral rinsing Advise "atient to avoid eating < to E h after treatment Advise "atients to avoid dental floss at the site of chi" insertion for ,6 days after "lacement because flossing might dislodge the chi" Instruct "atient to notify dentist "rom"tly if chi" dislodges Advise "atient that although mild to moderate sensitivity is normal during the first week after "lacement of the chi"# notify dentist if "ain# swelling# or other "roblems occur !atients will be randomised

4eafness; transient "arotitis; altered taste "erce"tion

iscellane!us

Staining of teeth and oral surfaces; increased calculus formation; minor irritation and su"erficial des0uamation of oral mucosa

Brand Name: ME27

(o"ical !re"arations

!roviding an o"timum

ME27 has been used

ME27 is of "ure herbal edible

"hysiological moisture necessary for regeneration and re"air Inducing an antiinflammatory effect# thereby reducing edema and erythema Creating an atmos"here unfavorable for bacterial and fungal coloni1ation Isolating and "rotecting e+"osed and in$ured nerve endings "roducing thereby an analgesic effect !roviding local nutrition for wound bed cells ?i0uefying the necrotic tissue Isolating and "rotecting the wound bed from environmental factors but at the same time maintaining drainage and gaseous e+change 9educing body

succesfully in the treatment of the following wounds. =irst degree burns# where the "ain relief and the fast healing are remarkable# e g sunburn Second degree burns# su"erficial and dee" If "ro"erly a""lied# no skin grating is needed and regeneration takes "lace from hair follicles and glands in the dermis and subcutaneous tissue (hird degree burns# to isolate the wounds# reduce "ain# and e+"edite non-surgical debridement of the necrotic tissue to "re"are the wound for grafting

origin No side effects to the "roduct have been re"orted so far# e+"ect for rare allergic reactions to sesame oil

to receive either. , Moist e+"osed burn ointment %ME27&# a""lied twice "er day with the assistance of nursing staff < !ovidone iodine "lus be"anthenol 2e"anthenol cream is self-a""lied or a""lied with the assistance of nursing "ersonnel twice "er day after the third or fourth day of thera"y with "ovidone iodine according to the degree of re"ithelili1ation (he burn wounds %both grou"s& were also treated and lightly debrided by antise"tic in the shower every second day by nursing or medical "ersonnel Also# dressing of the burn wounds during hos"itali1ation is not a""licable "rimarily because of considerable shortcomings in nursing "ersonnel

fluids loss from damaged skin %burns& Asborbing residual heat in acute burn wounds E+"editing e"itheliali1ation with e+ce"tionally acce"table cosmesis

4onor site# to decrease "ain# control infection# and e+"edite healing %average of C days has been re"orted& Chronic wounds including bed ulcers# diabetic food# and leg ulcers !ost laster resurfacing# chemical "eeling# and dermabrasion Surgical wounds including obstetrical wounds 5ound of circumcision Mucous membrane wounds such as buccal ulcers Cracked heels and cracked ni""les 9elief and "revention of

Generic Name: albuterol sulfate

2ronchodilator %thera"eutic&;

In low doses# acts relatively

Contraindicate d with

CNS. 9estlessness#

Assessment

Brand Name: Salbutamol

adrenergics %"harmacologic&

selectively at beta<adrenergic rece"tors to cause bronchodilation and vasodilation At higher doses# beta< selectivity is lost# and the drug acts at beta< rece"tors to cause ty"ical sym"athomime tic cardiac effects

bronchos"as m in "atients with reversible obstructive airway disease; Inhalation. (reatment of acute attacks of bronchos"as m; !revention of e+erciseinduced bronchos"as m;

hy"ersensitivit y to albuterol; tachyarrhythm ias# tachycardia caused by digitalis into+ication; general anesthesia with halogenated hydrocarbons or cyclo"ro"ane %these sensiti1e the myocardium to catecholamine s&; unstable vasomotor system disorders; hy"ertension; coronary insufficiency# CA4; history of stroke; C7!4 "atients with degenerative heart disease 'se cautiously with diabetes mellitus %large I) doses can aggravate diabetes and ketoacidosis&; hy"erthyroidis m; history of sei1ure disorders; "sychoneuroti

a""rehension# an+iety# fear# CNS stimulation# hy"erkinesia# insomnia# tremor# drowsiness# irritability# weakness# vertigo# headache

C). Cardiac arrhythmias# tachycardia# "al"itations# !)Cs %rare&# anginal "ain

*istory. *y"ersensitivity to albuterol; tachyarrhythmias# tachycardia caused by digitalis into+ication; general anesthesia with halogenated hydrocarbons or cyclo"ro"ane; unstable vasomotor system disorders; hy"ertension; coronary insufficiency# CA4; history of stroke; C7!4 "atients who have develo"ed degenerative heart disease; diabetes mellitus; hy"erthyroidism; history of sei1ure disorders; "sychoneurotic individuals; lactation

4ermatologic. Sweating# "allor# flushing

!hysical. 5eight; skin color# (# turgor; orientation# refle+es# affect; !# 2!; 9# adventitious sounds; blood and urine glucose# serum electrolytes# thyroid function tests# EC>

>I. Nausea# vomiting# heartburn# unusual or bad taste in mouth

Interventi!ns

>'. Increased incidence of leiomyomas of uterus when given in higher than human doses in "reclinical

'se minimal doses for minimal "eriods; drug tolerance can occur with "rolonged use

Maintain a beta-adrenergic blocker %cardioselective

c individuals; labor and delivery %oral use has delayed second stage of labor; "arenteral use of beta<adrenergic agonists can accelerate fetal heart beat and cause hy"oglycemia# hy"okalemia# "ulmonary edema in the mother and hy"oglycemia in the neonate&; lactation; the elderly %more sensitive to CNS effects&

studies

(es*irat!r-:

beta-blocker# such as atenolol# should be used with res"iratory distress& on standby in case cardiac arrhythmias occur

9es"iratory difficulties# "ulmonary edema# coughing# bronchos"asm# "arado+ical airway resistance with re"eated# e+cessive use of inhalation "re"arations

!re"are solution for inhalation by diluting 6 M m? 6 MD solution with < M m? normal saline; deliver over M/,M min by nebuli1ation

4o not e+ceed recommended dosage; administer "ressuri1ed inhalation drug forms during second half of ins"iration# because the airways are o"en wider and the aerosol distribution is more e+tensive

)eac&in$ *!ints 4o not e+ceed recommended dosage; adverse effects or loss of effectiveness may result 9ead the instructions that come with res"iratory inhalant

Gou may e+"erience these side effects. 4i11iness# drowsiness# fatigue# headache %use caution if driving or "erforming tasks that re0uire alertness&;

nausea# vomiting# change in taste %eat fre0uent small meals&; ra"id heart rate# an+iety# sweating# flushing# insomnia

Generic Name: !henytoin Brand Name: 4ilantin Infatabs

Central nervous system agent; anticonvulsant; hydantoin

Mechanism of action is still unknown A hydantoin derivative that "robably stabili1es neuronal membranes and limits sei1ure activity by either increasing reflu+ or decreasing influ+ of sodium ions across cell membranes in the motor corte+ during generation of nerve im"ulses

Control of tonic-clonic %grandma& and com"le+ "artial %(em"oral lobe& sei1ures

Contraindicate d in "atient hy"ersensitive to hydantoin and those with sinus bradycardia# SA block# second or third degree A) block or AdamsStrokes syndrome

=or "atient re0uiring a loading dose !revention and treatment of sei1ures occurring during neurosurgery Status E"ile"ticus

CNS. ata+ia# slurred s"eech# di11iness# insomnia# nervousness# twitching# headache# mental confusion# decreased coordination

9e"ort chest "ain# di11iness# insomnia# weakness# tremors or irregular heartbeat# difficulty breathing# "roductive cough# failure to res"ond to usual dosage 7bserve ten rights in giving medication

'se cautiously in "atients with he"atic dysfunction# hy"otension# myocardial infraction# diabetes# or res"iratory de"ression# in elderly or debilitated "atients and in those receiving other hydantoin derivatives

C). "eriateritis nodosa

EEN(. nystagmus# di"lo"ia# blurred vision

Elderly "atients tend to metaboli1e "henytoin slowly and may need reduced dosages

>I. gingival hy"er"lasia# nausea# vomiting# consti"ation

!henytoin re0uirements usually increase during "regnancy

Sto" drug if rash a""ears

*ematologic. thrombocyto"e nia# leuko"enia# megaloblastic anemia# agrunolocytosi s

'se only clear solution for in$ection A slight yellow color is acce"table 4onPt refrigerate

*e"atic. to+ic he"atitis

4onPt give I M unless dosage ad$ustments are made; drug may "reci"itate at in$ection site# cause "ain# and be absorbed erratically

Metabolic. hy"erglycemia

4ivided doses given with or after meals may decrease adverse >I reactions

Muscuskeletal. osteomalacia

Advise "atient to avoid alcohol

Skin. "ur"uric dermatitis# "hotosensitivity reactions# necrosis# inflammation at in$ection site# discoloration of skin if given by I) "ush in back of hand

5arm "atient not to sto" drug abru"tly because sei1ures may worsen

Stress im"ortance of good oral hygiene and regular dental e+aminations

Caution "atient that drug may have color "ink# red# or reddish brown urine

Generic Name: a1ithromycin Brand Name:

Macrolide antibiotic

(reatment of ?9Is. Acute bacterial

Contraindicate d with hy"ersensitivit

7ther. hirsutism# lym"hadeno"at hy CNS. 4i11iness# headache#

Assessment *istory. *y"ersensitivity to

;ithroma+

e+acerbations of C7!4 due to * influen1ae# Mora+ella catarrhalis# S "neumoniae; communityac0uired "neumonia due to S "neumoniae# * influen1ae (reatment of ?9Is. Stre"tococcal "haryngitis and tonsillitis due to Stre"tococcus "yogenes in those who cannot take "enicillins (reatment of uncom"licated skin infections due to Sta"hylococcu s aureus# S "yogenes# Stre"tococcus agalactiae (reatment of nongonococca l urethritis and cervicitis due to C trachomatis; treatment of !I4

y to a1ithromycin# erythromycin# or any macrolide antibiotic 'se cautiously with gonorrhea or sy"hilis# "seudomembr anous colitis# he"atic or renal im"airment# lactation

vertigo# somnolence# fatigue

>I. 4iarrhea# abdominal "ain# nausea# dys"e"sia# flatulence# vomiting# melena# "seudomembr anous 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# bowel sounds# liver evaluation; culture and sensitivity tests of infection# urinalysis# liver and renal function tests

Interventi!ns Culture site of infection before thera"y

Administer on an em"ty stomach , hr before or </E hr after meals =ood affects the absor"tion of this drug

Counsel "atients being treated for S(4s about a""ro"riate "recautions and additional thera"y

)eac&in$ *!ints (ake the full course "rescribed 4o not take with antacids (ake with food if >I u"set occurs

(reatment of acute sinusitis (reatment of otitis media caused by * influen1ae# M catarrhalis# S "neumoniae in children L H mo (reatment of "haryngitis and tonsillitis in children L < yr who cannot use first-line thera"y !revention and treatment of disseminated Mycobacteriu m avium com"le+ %MAC& in "atients with advanced AI4S 9e"lacement thera"y in adrenal cortical insufficiency Gou may e+"erience these side effects. Stomach cram"ing# discomfort# diarrhea; fatigue# headache %medication may hel"&; additional infections in the mouth or vagina %consult with health care "rovider for treatment&

9e"ort severe or watery diarrhea# severe nausea or vomiting# rash or itching# mouth sores# vaginal sores

Generic Name: hydrocortisone Brand Name: Cortef#*ydrocort one

Adrenal corticalsteroid Corticosteroid >lucocorticoid

Enters target cells and binds to cyto"lasmic rece"tor; initiates many com"le+ reactions that are res"onsible for its anti-inflammatory# immunosu""ressiv e %glucocorticoid&# and salt-retaining %mineralocorticoid& actions Some actions maybe

5 Aller$ic states8 Severe or inca"acitating allergicconditi ons*ematologicdi

C!ncentrati!ns Allergy to any com"onent of the drug =ungal infections Amebiasis *e"atitis 2 )accinia or varicella Antibioticresistant infections

Assessment 6 /ru$ Effects Establish baseline and continuing data on 2!# weight# fluid and electrolyte balance# and blood glucose

?ab tests. !eriodic serum electrolytes blood glucose# *ct and *gb# "latelet count#

undesirable# de"ending on drug use

sorders'lcerative colitis

Immunosu""r ession

and 52C with differential

,recauti!n 8idney disease ?iver disease Cirrhosis *y"othyroidis m 'lcerative colitis with im"ending "erforation 4iverticulitis 9ecent >I surgery Active or latent "e"tic ulcer Inflammatory bowel disease *y"ertension *eart failure (hromboembo lic tendencies 7steo"orosis Convulsive disorders Metastatic carcinoma 4iabetes mellitus (uberculosis ?actation

Monitor for adverse effects 7lder adults and "atients with low serum albumin are es"ecially susce"tible to adverse effects

2e alert to signs of hy"ocalcemia

7"hthalmosco"ic e+aminations are recommended every </E mo# es"ecially if "atient is receiving o"hthalmic steroid thera"y

Monitor for "ersistent backache or chest "ain; com"ression and s"ontaneous fractures of long bones and vertebrae "resent ha1ards

Monitor for and re"ort changes in mood and behavior# emotional instability# or "sychomotor activity# es"ecially with longterm thera"y

2e alert to "ossibility of masked infection and delayed healing %antiinflammatory and immunosu""ressive actions&

Note: Dose adjustment may be required if patient is subjected to severe stress (serious infection, surgery, or injury) Note: !ingle doses of corticosteroids or use for a short period ("# $%) do not produce $ithdra$al symptoms $hen discontinued, even $ith moderately large doses ,atient 6 7amil- Educati!n E+"ect a slight weight gain with im"roved a""etite After dosage is stabili1ed# notify "hysician of a sudden slow but steady weight increase @< kg %M lb&:wkB

Avoid alcohol and caffeine; may contribute to steroidulcer develo"ment in longterm thera"y

4o not ignore dys"e"sia with hy"eracidity 9e"ort sym"toms to "hysician and

do N7( self-medicate to find 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 advisable to reduce ris% of corticosteroid' induced osteoporosis Notify "hysician of slow healing# any vague feeling of being sick# or return to "retreatment sym"toms

4o not abru"tly discontinue drug; doses are gradually reduced to "revent withdrawal sym"toms

9e"ort e+acerbation of disease during drug withdrawal

Carry medical identification at all times It needs to indicate medical diagnosis# drug thera"y# and name of "hysician

A""ly to"ical "re"arations s"aringly in small children (he ha1ard of systemic to+icity is higher because of the greater ratio of skin surface area to body weight

Check shelf-life date on to"ical corticosterone during long-term use

Generic Name: Amino Acids Brand Name: (ravasol ,6D (ravasol %Amino Acid& In$ection administered via central vein will "rovide biologically utili1able source material for "rotein synthesis when used with concentrated calorie sources %such as hy"ertonic de+trose or fat emulsion&# electrolytes# vitamins# and minerals Administered "eri"herally after a""ro"riate dilution or with minimal calorie su""lementation %such as MD de+trose&# it enhances the M MD and J MD (ravasolQ %Amino Acid& In$ections are indicated as an ad$unct in the offsetting of nitrogen loss or in the treatment of negative nitrogen balance in "atients where. %,& the alimentary tract cannot or should not be used# %<& gastrointestina l absor"tion of "rotein is im"aired# or %E& metabolic re0uirements *y"ersensitivit y to one or more amino acids Severe liver damage or he"atic coma Anuria

CNS. 4i11iness# headache# confusion# loss of concentration# fever C). *y"ertension# C*=:"ulmonar y edema# flushing# thrombosis EN47. *y"erglycemia# rebound hy"oglycemia# electrolyte imbalances# hy"erosmolar hy"erglycemic nonketotic syndrome# alkalosis# hy"o"hos"hate

4o not breast feed while taking:using this drug without consulting "hysician Assess: Electrolytes %"otassium# sodium "hos"hate# chloride# magnesium# bicarbonate# blood glucose# ammonia# ketones& 9enal:he"atic studies. 2'N# creatinine# A?(# AS(# bilirubin 5eight Changes# triglycerides before and after infusion; vit A level with renal disease In$ection site for e+travasation. redness along vein# edema at site# necrosis# "ain# hard tender area; site should be changed immediately 4iscontinue infusion# culture tubing and sol Se"sis. chills# fever# increased tem"erature# if se"sis is sus"ected =or im"ending he"atic

conservation of body "rotein

for "rotein are substantially increased# as with e+tensive burns

mia# hy"erammone mia# dehydration# hy"ocalcemia

>I. Nausea# abdominal "ain >'. >lycosuria osmotic dieresis IIN(E>. E+travasation necrosis# "hlebitis at in$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 "revent infection every <---J hrs if chills# fever# other signs of infection occur Evaluate: (hera"eutic res"onse. weight gain# decrease in $aundice with liver disorders# increased ?7C )eac& *atient9famil-: 9eason for use of (!N If chills# sweating are e+"erienced to re"ort at once About infusion "um" and blood glucose