cefuroxime

DRUG NAME Generic Name: cefuroxime

DRUG ACTION Inhibits cell wall synthesis promoting osmotic instability usually bactericidal

INDICATION/ DOSAGE Perioperative prevention 750 mg 1 tab BID

CONTRAINDICATIONS

ADVERSE EFFECTS CV: phlebitis, thrombophlebitis GI: diarrhea, anorexia, vomiting Hematologic: hemolytic anemia, thrombocytopenia, transient neutropenia, eosinophilia

DRUG INTERACTIONS Aminoglycosides: May cause synergistic activity against some organisms.May increase nephrotoxicity. Monitor patients renal function closely.

NURSING CONSIDERATIONS Before giving dug. ask patient if she is allegic to penicillin or cephalosporin. Obtain specimen for culture and sensitivity tests before giving first dose. absorption of oral drug is induced.

Contraindicated in patients hypersensitive to drug or other cephalosporin. Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other beta lactam antibiotics

Brand Name: Xorimix

Pharmalogical Class: 2nd generation cephalosporin

Therapeutic Class: Cephalosporin

GENERIC NAME: Ranitidine BRAND NAME: Zantac

CLASSIFICATION Therapeutic: Anti-ulcer agents Pharmacologic: Histamine H2 antagonists

DOSAGE 20 mg IV q8h MECHANISM OF ACTION Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori. INDICATION Treatment and prevention of heartburn, acid indigestion, and sour stomach.

CONTRA INDICATIONS Contraindicated in: Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Use Cautiously in: Renal impair- ment Geriatric patients (more susceptible to adverse CNS reactions) Pregnancy or Lactation

SIDE EFFECTS/ ADVERSE EFFECTS

 CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis NURSING IMPLICATIONS/RESPONSIBILITIES Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray black.

Epinephrine (adrenaline)

Brand Name: epinephrine bitartrate Pregnancy Category C Drug classes: Sympathomimetic drug, Alpha-adrenergic agonist, Beta1 and beta2-adrenergic agonist, Cardiac stimulant, Vasopressor, Bronchodilator,Antiasthmatic drug, Nasal decongestant, Mydriatic, Antiglaucoma drug

Therapeutic actions Naturally occurring neurotransmitter, the effects of which are mediated by alpha or beta receptors in target organs. Effects on alpha receptors include vasoconstriction, contraction of dilator muscles of iris. Effects on beta receptors include positive chronotropic and inotropic effects on the heart (beta1 receptors); bronchodilation, vasodilation, and uterine relaxation (beta2receptors); decreased production of aqueous humor.

Indications Intravenous: In ventricular standstill after other measures have failed to restore circulation, given by trained personnel byintracardiac puncture and intramyocardial injection; treatment and prophylaxis of cardiac arrest and attacks of transitory AV heart block with syncopal seizures (Stokes-Adams syndrome); syncope due to carotid sinus syndrome; acute hypersensitivity (anaphylactoid) reactions, serum sickness, urticaria, angioneurotic edema; in acute asthmatic attacks to relieve bronchospasm not controlled by inhalation or SC injection; relaxation of uterine musculature; additive to local anesthetic solutions for injection to prolong their duration of action and limit systemic absorption Injection: Relief from respiratory distress of bronchial asthma, chronic bronchitis, emphysema, other COPDs Aerosols and solutions for nebulization: Temporary relief from acute attacks of bronchial asthma, COPD Topical nasal solution: Temporary relief from nasal and nasopharyngeal mucosal congestion due to a cold, sinusitis, hay fever, or other upper respiratory allergies; adjunctive therapy in middle ear infections by decreasing congestion around eustachianostia

 0.25%2% ophthalmic solutions: Management of open-angle (chronic simple) glaucoma, often in combination with miotics or other drugs 0.1% ophthalmic solution: Conjunctivitis, during eye surgery to control bleeding, to produce mydriasis

Contraindications Contraindicated with allergy or hypersensitivity to epinephrine or components of preparation (many of the inhalant and ophthalmic products contain sulfites: sodium bisulfite, sodium or potassiummetabisulfite; check label before using any of these products in a sulfite-sensitive patient); narrow-angle glaucoma; shock other than anaphylactic shock; hypovolemia; general anesthesia with halogenated hydrocarbons or cyclopropane; organic brain damage, cerebral arteriosclerosis; cardiac dilation and coronary insufficiency;tachyarrhythmias; ischemic heart disease; hypertension; renal dysfunction (drug may initially decrease renal blood flow); COPD patients who have developed degenerative heart disease; diabetes mellitus; hyperthyroidism; lactation.

Adverse effects Fear, anxiety, tenseness, restlessness, headache, light-headedness, dizziness, drowsiness, tremor, insomnia, hallucinations, psychological disturbances, convulsions, CNS depression, weakness, blurred vision, ocular irritation, tearing, photophobia, symptoms of paranoid schizophrenia Arrhythmias, hypertension resulting in intracranial hemorrhage, cardiovascular collapse with hypotension, palpitations, tachycardia,precordial pain in patients with ischemic heart disease Nausea, vomiting, anorexia Constriction of renal blood vessels and decreased urine formation (initialparenteral administration), dysuria, vesical sphincter spasm resulting in difficult and painful urination, urinary retention in males with prostatism Pallor, respiratory difficulty, orofacial dystonia, sweating

Headache, browache, blurred vision, photophobia, difficulty with night vision, pigmentary (adrenochrome) deposits in the cornea, conjunctiva, or lids with prolonged use Transitory stinging on initial instillation, eye pain or ache, conjunctivalhyperemia

Drug Interactions: Increased sympathomimetic effects with other TCAs (eg,imipramine) Excessive hypertension with propranolol, beta-blockers,furazolidone Decreased cardiostimulating and bronchodilating effects with beta-adrenergic blockers (eg, propranolol) Decreased vasopressor effects with chlorpromazine,phenothiazines Decreased antihypertensive effect of guanethidine, methyldopa

Nursing considerations Use extreme caution when calculating and preparing doses; epinephrine is a very potent drug; small errors in dosage can cause serious adverse effects. Double-check pediatric dosage. Use minimal doses for minimal periods of time; "epinephrine-fastness" (a form of drug tolerance) can occur with prolonged use. Protect drug solutions from light, extreme heat, and freezing; do not use pink or brown solutions. Drug solutions should be clear and colorless (does not apply to suspension for injection). Shake the suspension for injection well before withdrawing the dose. Rotate SC injection sites to prevent necrosis; monitor injection sites frequently. Maintain a rapidly acting alpha-adrenergic blocker (phentolamine) or a vasodilator (a nitrate) on standby in case of excessive hypertensive reaction.

 Maintain an alpha-adrenergic blocker or facilities for intermittent positive pressure breathing on standby in case pulmonary edema occurs. Maintain a beta-adrenergic blocker (propranolol; a cardioselectivebeta-blocker, such as atenolol, should be used in patients with respiratory distress) on standby in case cardiac arrhythmias occur. Do not exceed recommended dosage of inhalation products; administer pressurized inhalation drug forms during second half of inspiration, because the airways are open wider and the aerosol distribution is more extensive. If a second inhalation is needed, administer at peak effect of previous dose, 35 min. Use topical nasal solutions only for acute states; do not use for longer than 35 days, and do not exceed recommended dosage. Rebound nasal congestion can occur after vasoconstriction subsides.

OXACILLIN Classification Penicillins Action A penicillinase resistant penicillin that inhibits cell-wall synthesis during microorganism multiplication; bacteria resists penicillins by producing penicilllinase enzymes that convert penicillins to inactivate penecillic acids. Oxacillin resists these enzymes. Indications Systemic infections caused by penicillinase-producing staphylococci Adverse reactions Common: Thrombophebitis Uncommon: Neuropathy, neuromuscular irritability, lethargy, hallucination, anxiety, confusion, agitation, depression, dizziness, fatigue, oral lesions, nausea, vomiting, diarrhea, enterocolitis, interstitial nephritis, nephropathy, thrombocytopenia, hemolytic anemia, anemia, hypersensitivity reactions Nursing considerations Use cautiously in patients with other drug allergy, especially to cephalosporins. Obtain specimen for culture and sensitivity tests before first dose. To prevent vein irritation, avoid continuous infusions. Change site every 48 hours. Give 1-2 hours before or 2-3 hours after meals to prevent gastric irritation.

GENERIC NAME: prednisone

BRAND NAME: Deltasone, Orasone, Prednicen-M, Liquid Pred DRUG CLASS AND MECHANISM: Prednisone is an oral, synthetic (man-made) corticosteroid used for suppressing the immune system and inflammation. It has effects similar to other corticosteroids such as triamcinolone (Kenacort), methylprednisolone (Medrol), prednisolone(Prelone) and dexamethasone (Decadron). These synthetic corticosteroids mimic the action of cortisol (hydrocortisone), the naturally-occurring corticosteroid produced in the body by the adrenal glands. Corticosteroids have many effects on the body, but they most often are used for their potent antiinflammatory effects, particularly in those conditions in which the immune system plays an important role. Such conditions include arthritis, colitis, asthma, bronchitis, certain skin rashes, and allergic or inflammatory conditions of the nose and eyes. Prednisone is inactive in the body and, in order to be effective, first must be converted to prednisolone by enzymes in the liver. Therefore, prednisone may not work as effectively in people with liver disease whose ability to convert prednisone to prednisolone is impaired PRESCRIPTION: yes GENERIC AVAILABLE: yes PREPARATIONS: Tablets of 2.5, 5, 10, 20, and 50 mg. Oral solution or syrup of 5mg/5ml STORAGE: Store at room temperature 20-25C (68-77F), and keep away from moisture. PRESCRIBED FOR: Prednisone is used in the management of inflammatory conditions or diseases in which the immune system plays an important role. Since prednisone is used in so many conditions, only the most common or established uses are mentioned here. Prednisone most often is used for treating several types of arthritis, ulcerative colitis, Crohn's disease,systemic lupus, allergic reactions, asthma and severe psoriasis. It also is used for treating leukemias, lymphomas, idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia. Corticosteroids, including prednisone, are commonly used to suppress the immune system and prevent the body from rejecting transplanted organs. Prednisone is used as replacement therapy in patients whose adrenal glands are unable to produce sufficient amounts of cortisol. DOSING: The initial dose of prednisone varies depending on the condition being treated and the age of the patient. The starting dose may be from 5 to 60 mg per day and often is adjusted based on the response of the condition being treated. Corticosteroids typically do not produce immediate effects and must be used for several days before maximal effects are seen. It may take much longer before conditions respond to treatment. Prolonged therapy with prednisone causes the adrenal glands to atrophy

and stop producing cortisol. When prednisone is discontinued after a period of prolonged therapy, the dose of prednisone must be tapered (lowered gradually) to allow the adrenal glands time to recover. (See side effects.) It is recommended that prednisone be taken with food. DRUG INTERACTIONS: Prednisone may interact with estrogens andphenytoin (Dilantin). Estrogens may reduce the action of enzymes in the liver that break down (eliminate) the active form of prednisone, prednisolone. As a result, the levels of prednisolone in the body may increase and lead to more frequent side effects. Phenytoin increases the activity of enzymes in the liver that break down (eliminate) prednisone and thereby may reduce the effectiveness of prednisone. Thus, if phenytoin is being taken, an increased dose of prednisone may be required. PREGNANCY: Corticosteroids cross the placenta into the fetus. Compared to other corticosteroids, however, prednisone is less likely to cross the placenta. Chronic use of corticosteroids during the first trimester of pregnancy may cause cleft palate.