Generic Name: Albuterol

Brand Name:

Salbutamol, Proventil, Ventolin, Accuneb, airet, Novo-Salbutamol,

Proventil HFA, Gen-salbutamol, Ventodisk, Ventolin HFA, Volmax, VoSpira
ER

Classification:

Bronchodilator (therapeutic); adrenergics (pharmacologic)

Dosages

ADULTS
Oral

Initially, 2 or 4 mg (12 tsp syrup) tidqid PO; may cautiously

increase dosage if necessary to 4 or 8 mg qid, not to exceed 32
mg/day.
PEDIATRIC PATIENTS
Oral, tablets

612 yr: 2 mg tidqid. Do not exceed 24 mg/day.

> 12 yr: Use adult dosage.

Oral, syrup

< 2 yr: Safety and efficacy not established.

26 yr: Initially 0.1 mg/kg tid, not to exceed 2 mg (1 tsp) tid; if

necessary, cautiously increase stepwise to 0.2 mg/kg tid. Do not
exceed 4 mg (2 tsp) tid.

614 yr: 2 mg (1 tsp) tidqid; if necessary, cautiously increase

dosage. Do not exceed 24 mg/day in divided doses.

14 yr: Use adult dosage.

Inhalation

212 yr: For child 1015 kg, use 1.25 mg; for child > 15 kg, use 2.5
mg.

12 yr: Use adult dosage.

Solution for inhalation

1015 kg: 1.25 mg bid or tid by nebulization.

15 kg: 2.5 mg bid or tid by nebulization.

Inhalation capsules

> 4 yr: One 200 mcg capsule inhaled q 46 hr.

Prevention of exercise-induced asthma: One 200 mcg

capsule inhaled 15 min before exercise.

Relief and prevention of bronchospasm in patients with reversible

obstructive airway disease
Inhalation: Treatment of acute attacks of bronchospasm
Prevention of exercise-induced bronchospasm
Unlabeled use: Adjunct in treating serious hyperkalemia in dialysis
patients; seems to lower potassium concentrations when inhaled by
patients on hemodialysis

Mechanism Of Action

Indications

Contraindications& Cautions

Contraindicated with hypersensitivity to albuterol; tachyarrhythmias,

tachycardia caused by digitalis intoxication; general anesthesia with
halogenated hydrocarbons or cyclopropane (these sensitize the
myocardium to catecholamines); unstable vasomotor system
disorders; hypertension; coronary insufficiency, CAD; history of CVA;
COPD patients with degenerative heart disease.
Use cautiously with diabetes mellitus (large IV doses can aggravate
diabetes and ketoacidosis); hyperthyroidism; history of seizure
disorders; psychoneurotic individuals; labor and delivery (oral use
has delayed second stage of labor; parenteral use of beta2adrenergic agonists can accelerate fetal heart beat and cause
hypoglycemia, hypokalemia, pulmonary edema in the mother and
hypoglycemia in the neonate); lactation; the elderly (more sensitive
to CNS effects).

Drug to Drug Interactions

The pharmacologic effects of albuterol sulfate are attributable to activation of

beta2-adrenergic receptors on airway smooth muscle. Activation of beta2adrenergic receptors leads to the activation of adenylcyclase and to an
increase in the intracellular concentration of cyclic-3', 5'-adenosine
monophosphate (cyclic AMP).

Side effects

Nervousness, shaking (tremor), mouth/throat dryness or irritation, cough,

dizziness, headache, trouble sleeping, or nausea may occur

Adverse effect

CNS: Restlessness, apprehension, anxiety, fear, CNS stimulation,

hyperkinesia, insomnia, tremor, drowsiness, irritability, weakness,
vertigo, headache
CV: Cardiac arrhythmias, tachycardia, palpitations, PVCs (rare),
anginal pain
Dermatologic: Sweating, pallor, flushing
GI: Nausea, vomiting, heartburn, unusual or bad taste in mouth
GU: Increased incidence of leiomyomas of uterus when given in
higher than human doses in preclinical studies
Respiratory: Respiratory difficulties, pulmonary edema, coughing,
bronchospasm, paradoxical airway resistance with repeated,
excessive use of inhalation preparations

Nursing Considerations

Use minimal doses for minimal periods; drug tolerance can occur
with prolonged use.
Maintain a beta-adrenergic blocker (cardioselective beta-blocker,
such as atenolol, should be used with respiratory distress) on
standby in case cardiac arrhythmias occur.
Prepare solution for inhalation by diluting 0.5 mL 0.5% solution with
2.5 mL normal saline; deliver over 515 min by nebulization.
Do not exceed recommended dosage; administer pressurized
inhalation drug forms during second half of inspiration, because the
airways are open wider and the aerosol distribution is more
extensive.
Do not exceed recommended dosage; adverse effects or loss of
effectiveness may result. Read the instructions that come with
respiratory inhalant.
You may experience these side effects: Dizziness, drowsiness,
fatigue, headache (use caution if driving or performing tasks that
require alertness); nausea, vomiting, change in taste (eat frequent
small meals); rapid heart rate, anxiety, sweating, flushing, insomnia.
Report chest pain, dizziness, insomnia, weakness, tremors or
irregular heartbeat, difficulty breathing, productive cough, failure to
respond to usual dosage.

Generic Name Furosemide

Brand Name:

Apo-Furosemide (CAN),Furosemide Special (CAN), Lasix

Classification:

Loop diuretic
Pregnancy Category C

Dosages

ADULTS
Available forms :Tablets20, 40, 80 mg; oral solution10 mg/mL, 40 mg/5
mL; injection10 mg/mL
Pediatric Patients
Avoid use in premature infants: stimulates prostaglandin E2 synthesis and
may increase incidence of patent ductus arteriosus and complicate
respiratory distress syndrome.
Edema:

Initially, 2 mg/kg/day PO. If needed, increase by 12 mg/kg in 68

hr. Do not exceed 6 mg/kg.

Adjust maintenance dose to lowest effective level.

Pulmonary edema:

1 mg/kg IV or IM. May increase by 1 mg/kg in 2 hr until the desired

effect is seen. Do not exceed 6 mg/kg.
Patients with Renal Impairment

Up to 4 g/day has been tolerated.

IV bolus injection should not exceed 1 g/day given over 30 min.

Mechanism Of Action

Unclear. Thought to inhibit sodium and chloride reabsorption from

ascending loop of Henle and distal renal tubules. Increases
potassium excretion and plasma volume, promoting renal excretion of
water, sodium, chloride, magnesium, hydrogen, and calcium.

Indications

Contraindications& Cautions

Oral, IV: Edema associated with CHF, cirrhosis, renal disease

IV: Acute pulmonary edema
Oral: Hypertension

Severe sodium and water depletion, hypersensitivity to

sulphonamides and furosemide, hypokalaemia,
hyponatraemia, precomatose states associated with liver
cirrhosis, anuria or renal failure.

Addisons disease

Drug to Drug Interactions

Drug-drug.Aminoglycosides, ethacrynic acid, other ototoxic drugs:

increased risk of ototoxicity
Amphotericin B, corticosteroids, corticotropin, potassium-wasting
diuretics, stimulant laxatives: additive hypokalemia
Antihypertensives, diuretics, nitrates: additive hypotension
Cardiac glycosides: increased risk of glycoside toxicity and fatal
arrhythmias

Side effects

Nervousness, shaking (tremor), mouth/throat dryness or irritation, cough,

dizziness, headache, trouble sleeping, or nausea may occur

Adverse effect

CNS: dizziness, headache, vertigo, weakness, lethargy,

paresthesia, drowsiness, restlessness, light-headedness
CV: hypotension, orthostatic hypotension, tachycardia, volume
depletion, necrotizing angiitis, thrombophlebitis,
arrhythmias
EENT: blurred vision, xanthopsia, hearing loss, tinnitus
GI: nausea, vomiting, diarrhea, constipation, dyspepsia, oral
and gastric irritation, cramping, anorexia, dry mouth, acute
pancreatitis
GU: excessive and frequent urination, nocturia, glycosuria,
bladder spasm, oliguria, interstitial nephritis
Hematologic: anemia, purpura, leukopenia,
thrombocytopenia, hemolytic anemia
Hepatic: jaundice
Metabolic: hyperglycemia, hyperuricemia, dehydration,
hypokalemia, hypomagnesemia, hypocalcemia, alkalosis
Musculoskeletal: muscle pain, muscle cramps
Skin: photosensitivity, rash, diaphoresis, urticaria, pruritus,
exfoliative dermatitis, erythema multiforme
Other: fever, transient pain at I.M. injection site

Nursing Considerations

Record intermittent therapy on a calendar or dated

envelopes. When possible, take the drug early so increased
urination will not disturb sleep. Take with food or meals to
prevent GI upset.
Weigh yourself on a regular basis, at the same time and in
the same clothing, and record the weight on your calendar.
Blood glucose levels may become temporarily elevated in
patients with diabetes after starting this drug.
You may experience these side effects: Increased volume
and frequency of urination; dizziness, feeling faint on arising,
drowsiness (avoid rapid position changes; hazardous
activities, like driving; and consumption of alcohol); sensitivity
to sunlight (use sunglasses, wear protective clothing, or use a
sunscreen); increased thirst (suck on sugarless lozenges; use
frequent mouth care); loss of body potassium (a potassiumrich diet or potassium supplement will be needed).
Report loss or gain of more than 3 pounds in 1 day, swelling
in your ankles or fingers, unusual bleeding or bruising,
dizziness, trembling, numbness, fatigue, muscle weakness or
cramps.
Reduce dosage if given with other antihypertensives; readjust
dosage gradually as BP responds.
Administer with food or milk to prevent GI upset.
Give early in the day so that increased urination will not
disturb sleep.
Avoid IV use if oral use is at all possible.
WARNING: Do not mix parenteral solution with highly acidic
solutions with pH below 3.5.
Do not expose to light, may discolor tablets or solution; do not
use discolored drug or solutions.
Discard diluted solution after 24 hr.
Refrigerate oral solution.
Measure and record weight to monitor fluid changes.
Arrange to monitor serum electrolytes, hydration, liver and
renal function.
Arrange for potassium-rich diet or supplemental potassium as
needed.

Generic Name Diphenhydramine

hydrochloride

Brand Name:

Benadryl, Aler-Tab, Allergy, Allermax, Altaryl, Children's Allergy,

Diphen Cough, Diphenhist, Dytuss, Q-Dryl, Siladryl, Silphen Cough,
Simply Sleep, Sleep-ettes, Sominex Maximum Strength Caplet,
Theraflu Thin Strips Multi Symptom, Triaminic Thin Strips Cough &
Runny Nose, Unisom Sleepgels Maximum Strength, Valu-Dryl

Classification:

Pharmacologic class: Ethanolamine derivative, nonselective

histamine1-receptor antagonist
Therapeutic class: Antihistamine, antitussive, antiemetic,
antivertigo agent, antidyskinetic
Pregnancy risk category B

Dosages

Adults and children over age 12: 25 to 50 mg P.O. q 4 to 6 hours,

or 10 to 50 mg I.V. or I.M. q 2 to 3 hours p.r.n. (Some patients may
need up to 100 mg.) Don't exceed 400 mg/day.
Children ages 6 to 12: 12.5 to 25 mg P.O. q 4 to 6 hours, or 1.25
mg/kg (37.5 mg/m2) I.M. or I.V. q.i.d. Don't exceed 150 mg/day.
Children ages 2 to 5: 6.25 mg P.O. q 4 to 6 hours. Don't exceed 37.5
mg/day.

Mechanism Of Action

Interferes with histamine effects at histamine1-receptor sites;

prevents but doesn't reverse histamine-mediated response.
Also possesses CNS depressant and anticholinergic
properties.

Indications

Oral, IV: Edema associated with CHF, cirrhosis, renal disease

IV: Acute pulmonary edema
Oral: Hypertension

Contraindications& Cautions

Hypersensitivity to drug
Alcohol intolerance
Acute asthma attacks
MAO inhibitor use within past 14 days
Breastfeeding
Neonates, premature infants

Drug to Drug Interactions

Antihistamines, opioids, sedative-hypnotics: additive CNS

depression
Disopyramide, quinidine, tricyclic antidepressants: increased
anticholinergic effects
MAO inhibitors: intensified and prolonged anticholinergic
effects

Side effects

Adverse effect

1
2
3
4
5
6
7
8
9
10
11

Drowsiness
Constipation
Diarrhea
Dizziness
Dry mouth/nose/throat
Headache
Anorexia
N&V
Anxiety
GI upset
Asthenia

CNS: dizziness, headache, vertigo, weakness, lethargy,

paresthesia, drowsiness, restlessness, light-headedness
CV: hypotension, orthostatic hypotension, tachycardia, volume
depletion, necrotizing angiitis, thrombophlebitis,
arrhythmias
EENT: blurred vision, xanthopsia, hearing loss, tinnitus
GI: nausea, vomiting, diarrhea, constipation, dyspepsia, oral
and gastric irritation, cramping, anorexia, dry mouth, acute
pancreatitis
GU: excessive and frequent urination, nocturia, glycosuria,
bladder spasm, oliguria, interstitial nephritis
Hematologic: anemia, purpura, leukopenia,
thrombocytopenia, hemolytic anemia
Hepatic: jaundice
Metabolic: hyperglycemia, hyperuricemia, dehydration,
hypokalemia, hypomagnesemia, hypocalcemia, alkalosis
Musculoskeletal: muscle pain, muscle cramps
Skin: photosensitivity, rash, diaphoresis, urticaria, pruritus,
exfoliative dermatitis, erythema multiforme
Other: fever, transient pain at I.M. injection site

Nursing Considerations

1
2
3
4
5
6
7
8
9
10

Give full prophylactic dose 30min. prior to travel if used as a

prophylaxis for motion sickness
Take similar doses with meals and at bedtime
Do not use more than 2 weeks to treat insomnia
For IV, may give undiluted
Do not exceed IV rate of 25mg/minute
Drug causes drowsiness. Avoid activities requiring mental alertness
Use sun protection as it may cause photosensitivity
Use sugarless candy/gum to diminish dry mouth effects
Avoid alcohol and other CNS depressants
Stop therapy 72-96 hr. prior to skin testing. Report adverse effect

and lack of response Advise patient to avoid alcohol and other

depressants such as sedatives while taking drug.
11 Caution patient to avoid driving and other hazardous activities until he
knows how drug affects concentration and alertness.
12. As appropriate, review all other significant adverse reactions and
interactions, especially those related to the drugs, tests, herbs, and
behaviors mentioned above.

Generic Name Paracetamol,

Acetaminophen

Brand Name:

Biogesic, Panadol, Tylenol

Classification:

Non-narcotic analgesic, Antipyretic, Abenol (CA), Acephen, Anadin

Paracetamol (UK), Apo-Acetaminophen (CA), Aspirin Free Anacin,
Atasol (CA), Calpol (UK), Cetaphen, Children's Tylenol Soft Chews,
Disprol (UK), Feverall, Galpamol (UK), Genapap, Little Fevers,
Mandanol (UK), Mapap, Nortemp, Nortemp Children's, Novo-Gesic
(CA), Pain Eze, Panadol (UK), Pediatrix (CA), Silapap, Tempra (CA),
Tycolene, Tylenol 8 Hour, Tylenol, Tylenol Arthritis, Tylenol Extra
Strength, Valorin

Dosages

Per Orem: 325-650mg q4h up to a maximum of 1 gram q6h.

Suppositories: 650mg q4h not to exceed 4 grams a day for up to 10
days.

Mechanism Of Action

Pain relief may result from inhibition of prostaglandin synthesis

in CNS, with subsequent blockage of pain impulses. Fever
reduction may result from vasodilation and increased peripheral
blood flow in hypothalamus, which dissipates heat and lowers
body temperature.

Indications

Contraindications& Cautions
Drug to Drug Interactions

Side effects

Adverse effect

Nursing Considerations

Oral, IV: Edema associated with CHF, cirrhosis, renal disease

IV: Acute pulmonary edema
Oral: Hypertension
1
2

Renal Insufficiency
Anemia

Antihistamines, opioids, sedative-hypnotics: additive CNS

depression
Disopyramide, quinidine, tricyclic antidepressants: increased
anticholinergic effects
MAO inhibitors: intensified and prolonged anticholinergic
effects
1
2
3
4
5
6
7
8
9
10
11
12
13
14

Minimal GI upset.
Methemoglobinemia
Hemolytic Anemia
Neutropenia
Thrombocytopenia
Pancytopenia
Leukopenia
Urticaria
CNS stimulation
Hypoglycemic coma
Jaundice
Glissitis
Drowsiness
Liver Damage

Hematologic: thrombocytopenia, hemolytic anemia, neutropenia,

leukopenia, pancytopenia Hepatic: jaundice, hepatotoxicity Metabolic:
hypoglycemic coma
Skin: rash, urticaria
Other: hypersensitivity reactions (such as fever)
1
2
3
4
5
6
7
8
9
10
11
12
13
14

Do not exceed 4gm/24hr. in adults and 75mg/kg/day in

children.
Do not take for >5days for pain in children, 10 days for pain
in adults, or more than 3 days for fever in adults.
Extended-Release tablets are not to be chewed.
Monitor CBC, liver and renal functions.
Assess for fecal occult blood and nephritis.
Avoid using OTC drugs with Acetaminophen.
Take with food or milk to minimize GI upset.
Report N&V. cyanosis, shortness of breath and abdominal
pain as these are signs of toxicity.
Report paleness, weakness and heart beat skips
Report abdominal pain, jaundice, dark urine, itchiness or
clay-colored stools.
Phenmacetin may cause urine to become dark brown or
wine-colored.
Report pain that persists for more than 3-5 days
Avoid alcohol.
This drug is not for regular use with any form of liver
disease.

Generic Name ranitidine

hydrochloride

Brand Name:

Acid Reducer (CA), Apo-Ranitidine (CA), Co Ranitidine (CA), Gavilast

(UK), Histac (UK), Raciran (UK), Ranitil (UK), Rantek (UK), Zantac,
Zantac 75, Zantac EFFERdose

Classification:

Pharmacologic class: Histamine2-receptor antagonist

Therapeutic class: Antiulcer drug
Pregnancy risk category B

Dosages

Adults and children over age 12: 25 to 50 mg P.O. q 4 to 6 hours,

or 10 to 50 mg I.V. or I.M. q 2 to 3 hours p.r.n. (Some patients may
need up to 100 mg.) Don't exceed 400 mg/day.
Children ages 6 to 12: 12.5 to 25 mg P.O. q 4 to 6 hours, or 1.25
mg/kg (37.5 mg/m2) I.M. or I.V. q.i.d. Don't exceed 150 mg/day.
Children ages 2 to 5: 6.25 mg P.O. q 4 to 6 hours. Don't exceed 37.5
mg/day.

Mechanism Of Action

Reduces gastric acid secretion and increases gastric mucus

and bicarbonate production, creating a protective coating on
gastric mucosa

Indications

Short-term treatment of active duodenal ulcer

Maintenance therapy for duodenal ulcer at reduced dosage
Short-term treatment of active, benign gastric ulcer
Short-term treatment of GERD
Pathologic hypersecretory conditions (eg, Zollinger-Ellison
syndrome)
Treatment of erosive esophagitis
Treatment of heartburn, acid indigestion, sour stomach

Contraindications& Cautions

Hypersensitivity to drug or its components

Alcohol intolerance (with some oral products)
History of acute porphyria

Drug to Drug Interactions

Antacids: decreased ranitidine absorption

Propantheline: delayed ranitidine absorption and increased
peak blood level

Side effects

Adverse effect

Nursing Considerations

chest pain, fever, feeling short of breath,

coughing up green or yellow mucus;
easy bruising or bleeding, unusual weakness;
fast or slow heart rate;
problems with your vision;
fever, sore throat, and headache with a severe
blistering, peeling, and red skin rash

CNS: headache, agitation, anxiety

GI: nausea, vomiting, diarrhea, constipation, abdominal
discomfort or pain
Hematologic: reversible granulocytopenia and
thrombocytopenia
Hepatic: hepatitis
Skin: rash
Other: pain at I.M. injection site, burning or itching at I.V. site,
hypersensitivity reaction

Take drug with meals and at bedtime. Therapy may continue for 46
weeks or longer.

If you also are using an antacid, take it exactly as prescribed, being

careful of the times of administration.

Have regular medical follow-up care to evaluate your response.

You may experience these side effects: Constipation or diarrhea

(request aid from your health care provider); nausea, vomiting (take
drug with meals); enlargement of breasts, impotence or decreased
libido (reversible); headache (adjust lights and temperature and
avoid noise).

Report sore throat, fever, unusual bruising or bleeding, tarry stools,

confusion, hallucinations, dizziness, severe headache, muscle or
joint pain.
Tell patient smoking may decrease drug effects.
As appropriate, review all other significant and life-threatening adverse
reactions and interactions, especially those related to the drugs,
tests, herbs, and behaviors mentioned above.

Generic Name Amikacin sulfate

Brand Name:

Amikin

Classification:

Anti-infective; Aminoglycoside
Pregnancy Category: C

Dosages

Moderate to Severe Infections

Adult: IV/IM 57.5 mg/kg loading dose, then 7.5 mg/kg q12h

Child: IV/IM 57.5 mg/kg loading dose, then 5 mg/kg q8h or

7.5 mg/kg q12h

Neonate: IV/IM 10 mg/kg loading dose, then 7.5 mg/kg q12

24h
Uncomplicated UTI

Adult: IV/IM 250 mg q12h

Administration
Intramuscular

Use the 250 mg/mL vials for IM injection. Calculate the

required dose and withdraw the equivalent number of mLs
from the vial.

Give deep IM into a large muscle.

Intravenous

Verify correct IV concentration and rate of infusion with

physician for neonates, infants, and children.

Mechanism Of Action
Indications

Contraindications& Cautions

Interferes with protein synthesis in bacterial cells by binding to 30S

ribosomal subunit, leading to bacterial cell death
Severe systemic infections caused by sensitive strains of
Pseudomonas aeruginosa, Escherichia coli, or
Proteus, Klebsiella, Serratia, Enterobacter,
Actinobacter, Providencia, Citrobacter, or
Staphylococcus species

Drug to Drug Interactions

Side effects

History of hypersensitivity or toxic reaction with

an aminoglycoside antibiotic.
Safety during pregnancy (category C), lactation,
neonates and infants, or use period exceeding
14 years old is not established.

Acyclovir, amphotericin B, cephalosporin, cisplatin, diuretics,

vancomycin: increased risk of ototoxicity and nephrotoxicity
Depolarizing and nondepolarizing neuromuscular junction blockers,
general anesthetics: increased amikacin effect, possibly leading to
respiratory depression
Dimenhydrinate: masking of ototoxicity signs and symptoms
Indomethacin: increased trough and peak amikacin levels
Parenteral penicillin: amikacin inactivation

an allergic reaction (shortness of breath; closing

of the throat; hives; swelling of the lips, face, or
tongue; rash; or fainting);
little or no urine;
decreased hearing or ringing in the ears;
dizziness, clumsiness, or unsteadiness;
numbness, skin tingling, muscle twitching, or
seizures; or
severe watery diarrhea and abdominal cramps.

Adverse effect

CNS: dizziness, vertigo, tremor, numbness, depression,

confusion, lethargy, headache, paresthesia, ataxia,
neuromuscular blockade, seizures, neurotoxicity
CV: hypotension, hypertension, palpitations
EENT: nystagmus and other visual disturbances, ototoxicity,
hearing loss, tinnitus
GI: nausea, vomiting, splenomegaly, stomatitis, increased
salivation, anorexia
GU: azotemia, increased urinary excretion of casts, polyuria,
painful urination, impotence, nephrotoxicity Hematologic:
purpura, eosinophilia, leukemoid reaction, aplastic anemia,
neutropenia, agranulocytosis, leukopenia, thrombocytopenia,
pancytopenia, hemolytic anemia
Hepatic: hepatomegaly, hepatic necrosis, hepatotoxicity
Musculoskeletal: joint pain, muscle twitching
Respiratory: apnea
Skin: rash, alopecia, urticaria, itching, exfoliative dermatitis
Other: weight loss, superinfection, pain and irritation at I.M. site

Nursing Considerations

Baseline tests: Before initial dose, C&S; renal function and

vestibulocochlear nerve function (and at regular intervals
during therapy; closely monitor in the older adult, patients
with documented ear problems, renal impairment, or during
high dose or prolonged therapy).

Monitor peak and trough amikacin blood levels: Draw blood 1

h after IM or immediately after completion of IV infusion; draw
trough levels immediately before the next IM or IV dose.

Lab tests: Periodic serum creatinine and BUN, complete

urinalysis. With treatment over 10 d, daily tests of renal
function, weekly audiograms, and vestibular tests are strongly
advised.

Monitor serum creatinine or creatinine clearance (generally

preferred) more often, in the presence of impaired renal
function, in neonates, and in the older adult; note that
prolonged high trough (>8 mg/mL) or peak (>3035 mg/mL)
levels are associated with toxicity.

Monitor S&S of ototoxicity (primarily involves the cochlear

(auditory) branch; high-frequency deafness usually appears
first and can be detected only by audiometer); indicators of
declining renal function; respiratory tract infections and other
symptoms indicative of superinfections and notify physician
should they occur.

Monitor for and report auditory symptoms (tinnitus, roaring

noises, sensation of fullness in ears, hearing loss) and
vestibular disturbances (dizziness or vertigo, nystagmus,
ataxia).

Monitor & report any changes in I&O, oliguria, hematuria, or

cloudy urine. Keeping patient well hydrated reduces risk of
nephrotoxicity; consult physician regarding optimum fluid
intake.
Patient & Family Education

Report immediately any changes in hearing or unexplained

ringing/roaring noises or dizziness, and problems with
balance or coordination.

Do not breast feed while taking this drug without consulting

physician.