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)

DosagesADULTSOralInitially, 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, tablets612 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.Inhalation212 yr: For child 1015 kg, use 1.25 mg; for child > 15 kg, use 2.5 mg.12 yr: Use adult dosage.Solution for inhalation1015 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.

Mechanism Of Action

Indications Relief and prevention of bronchospasm in patients with reversible obstructive airway diseaseInhalation: Treatment of acute attacks of bronchospasmPrevention of exercise-induced bronchospasmUnlabeled use: Adjunct in treating serious hyperkalemia in dialysis patients; seems to lower potassium concentrations when inhaled by patients on hemodialysis

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 beta2-adrenergic 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 beta2-adrenergic 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, headacheCV: Cardiac arrhythmias, tachycardia, palpitations, PVCs (rare), anginal painDermatologic: Sweating, pallor, flushingGI: Nausea, vomiting, heartburn, unusual or bad taste in mouthGU: Increased incidence of leiomyomas of uterus when given in higher than human doses in preclinical studiesRespiratory: 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 diureticPregnancy Category C

DosagesADULTSAvailable forms :Tablets20, 40, 80 mg; oral solution10 mg/mL, 40 mg/5 mL; injection10 mg/mL

Pediatric PatientsAvoid 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 ImpairmentUp 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 Oral, IV: Edema associated with CHF, cirrhosis, renal diseaseIV: Acute pulmonary edemaOral: Hypertension

Contraindications& Cautions 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 ototoxicityAmphotericin B, corticosteroids, corticotropin, potassium-wasting diuretics, stimulant laxatives: additive hypokalemiaAntihypertensives, diuretics, nitrates: additive hypotensionCardiac 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-headednessCV: hypotension, orthostatic hypotension, tachycardia, volume depletion, necrotizing angiitis, thrombophlebitis, arrhythmiasEENT: blurred vision, xanthopsia, hearing loss, tinnitusGI: nausea, vomiting, diarrhea, constipation, dyspepsia, oral and gastric irritation, cramping, anorexia, dry mouth, acute pancreatitisGU: excessive and frequent urination, nocturia, glycosuria, bladder spasm, oliguria, interstitial nephritisHematologic: anemia, purpura, leukopenia, thrombocytopenia, hemolytic anemiaHepatic: jaundiceMetabolic: hyperglycemia, hyperuricemia, dehydration, hypokalemia, hypomagnesemia, hypocalcemia, alkalosisMusculoskeletal: muscle pain, muscle crampsSkin: photosensitivity, rash, diaphoresis, urticaria, pruritus, exfoliative dermatitis, erythema multiformeOther: 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 potassium-rich 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 antagonistTherapeutic class: Antihistamine, antitussive, antiemetic, antivertigo agent, antidyskineticPregnancy risk category B

DosagesAdults 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 diseaseIV: Acute pulmonary edemaOral: 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 depressionDisopyramide, quinidine, tricyclic antidepressants: increased anticholinergic effectsMAO inhibitors: intensified and prolonged anticholinergic effects

Side effects 1Drowsiness2Constipation3Diarrhea4Dizziness5Dry mouth/nose/throat6Headache7Anorexia8N&V9Anxiety10GI upset11Asthenia

Adverse effect CNS: dizziness, headache, vertigo, weakness, lethargy, paresthesia, drowsiness, restlessness, light-headednessCV: hypotension, orthostatic hypotension, tachycardia, volume depletion, necrotizing angiitis, thrombophlebitis, arrhythmiasEENT: blurred vision, xanthopsia, hearing loss, tinnitusGI: nausea, vomiting, diarrhea, constipation, dyspepsia, oral and gastric irritation, cramping, anorexia, dry mouth, acute pancreatitisGU: excessive and frequent urination, nocturia, glycosuria, bladder spasm, oliguria, interstitial nephritisHematologic: anemia, purpura, leukopenia, thrombocytopenia, hemolytic anemiaHepatic: jaundiceMetabolic: hyperglycemia, hyperuricemia, dehydration, hypokalemia, hypomagnesemia, hypocalcemia, alkalosisMusculoskeletal: muscle pain, muscle crampsSkin: photosensitivity, rash, diaphoresis, urticaria, pruritus, exfoliative dermatitis, erythema multiformeOther: fever, transient pain at I.M. injection site

Nursing Considerations 1Give full prophylactic dose 30min. prior to travel if used as a prophylaxis for motion sickness2Take similar doses with meals and at bedtime3Do not use more than 2 weeks to treat insomnia4For IV, may give undiluted5Do not exceed IV rate of 25mg/minute6Drug causes drowsiness. Avoid activities requiring mental alertness7Use sun protection as it may cause photosensitivity8Use sugarless candy/gum to diminish dry mouth effects9Avoid alcohol and other CNS depressants10Stop 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

DosagesPer 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 Oral, IV: Edema associated with CHF, cirrhosis, renal diseaseIV: Acute pulmonary edemaOral: Hypertension

Contraindications& Cautions 1Renal Insufficiency2Anemia

Drug to Drug Interactions Antihistamines, opioids, sedative-hypnotics: additive CNS depressionDisopyramide, quinidine, tricyclic antidepressants: increased anticholinergic effectsMAO inhibitors: intensified and prolonged anticholinergic effects

Side effects 1Minimal GI upset.2Methemoglobinemia3Hemolytic Anemia4Neutropenia5Thrombocytopenia6Pancytopenia7Leukopenia8Urticaria9CNS stimulation10Hypoglycemic coma11Jaundice12Glissitis13Drowsiness14Liver Damage

Adverse effect Hematologic: thrombocytopenia, hemolytic anemia, neutropenia, leukopenia, pancytopenia Hepatic: jaundice, hepatotoxicity Metabolic: hypoglycemic comaSkin: rash, urticariaOther: hypersensitivity reactions (such as fever)

Nursing Considerations 1Do not exceed 4gm/24hr. in adults and 75mg/kg/day in children.2Do not take for >5days for pain in children, 10 days for pain in adults, or more than 3 days for fever in adults.3Extended-Release tablets are not to be chewed.4Monitor CBC, liver and renal functions.5Assess for fecal occult blood and nephritis.6Avoid using OTC drugs with Acetaminophen.7Take with food or milk to minimize GI upset.8Report N&V. cyanosis, shortness of breath and abdominal pain as these are signs of toxicity.9Report paleness, weakness and heart beat skips10Report abdominal pain, jaundice, dark urine, itchiness or clay-colored stools.11Phenmacetin may cause urine to become dark brown or wine-colored.12Report pain that persists for more than 3-5 days13Avoid alcohol.14This 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 antagonistTherapeutic class: Antiulcer drugPregnancy risk category B

DosagesAdults 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 ulcerMaintenance therapy for duodenal ulcer at reduced dosageShort-term treatment of active, benign gastric ulcerShort-term treatment of GERDPathologic hypersecretory conditions (eg, Zollinger-Ellison syndrome)Treatment of erosive esophagitisTreatment 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 absorptionPropantheline: delayed ranitidine absorption and increased peak blood level

Side effects 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

Adverse effect CNS: headache, agitation, anxietyGI: nausea, vomiting, diarrhea, constipation, abdominal discomfort or painHematologic: reversible granulocytopenia and thrombocytopeniaHepatic: hepatitisSkin: rashOther: pain at I.M. injection site, burning or itching at I.V. site, hypersensitivity reaction

Nursing Considerations 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; AminoglycosidePregnancy Category: C

DosagesModerate to Severe InfectionsAdult: IV/IM 57.5 mg/kg loading dose, then 7.5 mg/kg q12hChild: IV/IM 57.5 mg/kg loading dose, then 5 mg/kg q8h or 7.5 mg/kg q12hNeonate: IV/IM 10 mg/kg loading dose, then 7.5 mg/kg q1224hUncomplicated UTIAdult: IV/IM 250 mg q12h

Administration

IntramuscularUse 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.IntravenousVerify correct IV concentration and rate of infusion with physician for neonates, infants, and children.

Mechanism Of Action Interferes with protein synthesis in bacterial cells by binding to 30S ribosomal subunit, leading to bacterial cell death

Indications Severe systemic infections caused by sensitive strains of Pseudomonas aeruginosa, Escherichia coli, or Proteus, Klebsiella, Serratia, Enterobacter, Actinobacter, Providencia, Citrobacter, or Staphylococcus species

Contraindications& Cautions 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.

Drug to Drug Interactions Acyclovir, amphotericin B, cephalosporin, cisplatin, diuretics, vancomycin: increased risk of ototoxicity and nephrotoxicityDepolarizing and nondepolarizing neuromuscular junction blockers, general anesthetics: increased amikacin effect, possibly leading to respiratory depressionDimenhydrinate: masking of ototoxicity signs and symptomsIndomethacin: increased trough and peak amikacin levelsParenteral penicillin: amikacin inactivation

Side effects 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; orsevere watery diarrhea and abdominal cramps.

Adverse effect CNS: dizziness, vertigo, tremor, numbness, depression, confusion, lethargy, headache, paresthesia, ataxia, neuromuscular blockade, seizures, neurotoxicityCV: hypotension, hypertension, palpitationsEENT: nystagmus and other visual disturbances, ototoxicity, hearing loss, tinnitusGI: nausea, vomiting, splenomegaly, stomatitis, increased salivation, anorexiaGU: azotemia, increased urinary excretion of casts, polyuria, painful urination, impotence, nephrotoxicity Hematologic: purpura, eosinophilia, leukemoid reaction, aplastic anemia, neutropenia, agranulocytosis, leukopenia, thrombocytopenia, pancytopenia, hemolytic anemiaHepatic: hepatomegaly, hepatic necrosis, hepatotoxicityMusculoskeletal: joint pain, muscle twitchingRespiratory: apneaSkin: rash, alopecia, urticaria, itching, exfoliative dermatitisOther: 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 EducationReport 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.