icu&er drugs

8/11/2019 Icu&Er Drugs

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....

Commonly !"# #$%! &n

'm"$%"n(y ) *C+

/-,

5 000000000000000423 0000000000000000001

6oon l&%78

?;9:00000000

@$!&n% Ao(8o$

BB1DEEF

0


2/168


3/168


4/168

A$% GH%" A$% GH%"

$. +cetamino!hen

?

). +cetylsalicylic +cid A

>. +cti"ated ,harcoal B

;. +drenaline

C

?. +llumag

$0

A. +llo!urinol

$$

D. +mikacin

$)

B. +mino!hylline

$>

C. +miodarone$;

$0.+m!icillin

$A

$$.+m!hotercin

$D

$).+tenolol

$B

$>.+tor"astatin

$C

$;.+tracrium

)0

$?.+tro!ine

)$

$A.5iso!rolol

))

$D.,alcium

)>

$B.,a!to!ril

)?

$C.,ar"edilol

)D

)0.,efa9olin)B

)$.,efota3ime E ,laforan F

)C

)).,efta9idime F 8ortum F

>0

)>.,eftria3one E 2oce!hin F

>$

>


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);.,efuro3ime E Ginacef E

>)

)?.,hloram!henicol

>;

)A.,hlor!roma9ine

>?

)D.,i!roflo3acin

>A

)B.,lindamycin

>D

)C.,lo3acilin

>C

>0.6e3amethasone

;0

>$.6ia9e!am F+ssi"al

;)

>).6iclofenac Sodium

;>

>>.6igo3in

;?

>;.6iltia9im

;A

>?.6obutamine

;B

>A.6o!amine?0

>D.6o3ycyclin

?)

>B.1nala!ril

??

>C. 1no3a!arin F,le3aneF

?D

;0.1!hdrine

?C

;$.1rythromycin

A)

;).1some!ra9ole

AD

;>.8entanyl

AC

;;.8luma9enil F +ne3ateF D$

;?.8urosemiade

D>

;A.%entamycin

D?

;D.%libenclamide E 6aonil E DA

;B.%lucagon

DD

;C.7alo!eridol

DB?0.7e!arin

B$

?$.7uman +lbumin B>

?).7ydrocortisone

B;

?>.7ydrala9ine

BD

?;.7yoscine 5utyl!romide

BB

??.I!rtro!ium 5romide BC

?A.Iso!roterenol

C$

?D.etamine

C>

;


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?B.Lidocaine

C;

?C.4agnesium Sul!hate CA

A0.4annitol

CD

A$.4e!eridine F Pethidine F CC

A).4etformin

$0$

A>.4ethyl!rednisolone

$0)

A;.4etoclo!ramide

$0;

A?.4etronida9ole

$0?

AA.4ida9olam

$0D

AD.4or!hine

$0BAB./acetylcystine

$$0

AC./alo3ane

$$$

D0./efidi!ine

$$)

D$./eostigmine$$;

D)./itrates

$$?

D>./itro!russide

$$A

D;./oradrenaline

$$B

D?.Ome!ra9ole

$)0

DA.Octreotide F SandostatinE $)$

DD. O3ytocin

$)>

DB.Pancuronium

$);

DC.Penicillin %

$)?

B0.Phenobar!itol

$)A

B$.Phenytoin

$)B

B).Potassium ,hloride

$)C

B>.Prednisolone

$>0

B;.Prometha9ine$>>

B?.Pro!ofol

$>;

BA.Pro!ranolol

$>A

BD.Protamine Sul!hate $>D

BB.Huinidine Sul!hate $>B

BC.2anitidine

$;0

C0.2egular Insulin $;$

C$.Salbutamol E


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C>.S!ironolactone

$;A

C;.Stre!tokinase

$;D

C?.Succinyl ,holine

$;B

CA.*hio!ental Sodium E

PentothalE$;C

CD.*hyro3ine E 1ltro3inE $?$

CB.*rane3amic acid E $?>

CC.


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Commonly !"# #$%! &n 'm"$%"n(y Hn# *C+

S. GH$H("8Hmol T , T L("8Hm&noK7"n

U$H#" nHm"!&acamol !anadol

ClH!!, anti!yretic non o!ioid analgesic Paraamino!henol ty!e.

G$"%nHn(y,',ategory 5(L(8&on,+cetamino!hen decrease fe"er by an effect on hy!othalamus

leading to sweating J "asodilatation.

It also inhibits the effect of !yrogens on the heatregulating

,enter on the hy!othalamus.

It may cause analgesia by inhibiting ,/S !rostaglandin syntheses

So it has no antiinflammatory effect.

It doesnKt manifest any anticoagulant effect or any ulceration of %I*.+!"!,

Pain due to 7eadache dysmenorrhea arthralgia myalgia muscluoskletal !ain

immuni9ation teething tonsillectomy.

*o reduce fe"er due to bacterial J "iral infection.

+s a substitute for as!irin when contraindicated.

Con8$H&n#&(H8&on!,

2enal insufficiency anemia.V" "II"(8!,

,hronic J e"en acute to3icity can occur after long sym!tomfree usage.

7emolytic anemia neutro!nea thrombocyto!enia

Skin rashes fe"er aundice and hy!oglycemia.

Sym!toms of o"er dosage&

7e!atic to3icity general malaise delirium de!ression sei9ures

,oma J death nausea "omiting fe"er and "ascular colla!se.

U$"H8m"n8 oI oQ"$#o!",

$ Induction of emesis.

) %astric la"age.

> +cti"ated charcoal.

; Oral /acetyleystine 'mucomyst( is said to reduce or !re"ent he!atic damage

by inacti"ating acetamino!hen metabolites which cause li"er effects.

Ao!",by mouth 0.?M$ g e"ery ;MA hours to a ma3. Of ; g daily-

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C7&l#,

) months A0 mg for !ostimmuni9ation !yre3ia-

Otherwise under > months 'on doctorEs ad"ice only( $0 mgNkg

'? mgNkg if aundiced(-

> monthsM$ year A0M$)0 mg

$M? years $)0M)?0 mg

AM$) years )?0M?00 mg-

*hese doses may be re!eated e"ery ;MA hours when necessary

'4a3. of ; doses in ); hours(

@$!&n% (on!"$H8&on!,$ Su!!ositories should be stored below )D,.

) Li"er function studies for long term thera!y.> /ote signs of methemoglobinemia& bluish discoloration of gum J fingernails.

; 7a"e mucomyst a"ailable for signs of to3icity.

? *each !atient signs of to3icity to be re!orted immediately.

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D. L("8yl!Hl&(yl&( L( W L!K&$&n W ,

U$H#" nHm",+s!irin

ClH!!&I&(H8&on,

/onnarcotic analgesic anti!yretic antiinflammatory antirhumatic ant !latelet

/S+I6.

G$"%nHn(y,',ategory ,(

L(8&on,

*he anti!yretic effect is due to an action on the hy!othalamus that results in heat

loss by "asodilatation of !eri!heral blood "essels J !romoting sweating.

*he antiinflammatory effects !robably by decreasing !rostaglandin synthesis J

other mediators of the !ain res!onse.

*he analgesic action is not fully known but may be due to im!ro"ement of the

inflammatory condition .

@.M.&+s!irin also !roduces inhibition of !latelet aggregation.

+!"!,

Pain 4yalgia

+rthralgia 7eadache

6ysmenorrhea +nti!yretic 'reduce fe"er(

B


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11/168

+na!hyla3is

Skin rashes.

Increase bleeding time.

VHl&(ylH8" 8oX&(&8y- Salicylism&nausea "omiting di99iness tinnitus difficulty hearing diarrhea

mental confusion.

- +cute as!irin !oisoning&2es!iratory alkalosis hy!er!nea tach!nea

hemorrhage confusion !ulmonary edema con"ulsion tetany metabolic

acidosis.

A$% &n8"$H(8&on!,

2isk for bleeding increase if taken with other anticoagulants.2isk of %I bleeding increase if taken with steroids alcohol or other /S+I/6s.

Increased risk for salicylate to3icity if taken with frusimide 'lasi3(

7y!otension may occur if taken with nitroglycerin.

@$!&n% (on!"$H8&on!,

$.*ake drug with or after food or with milk to decrease %I irritation.

).+ssess for history of asthma and history of hy!ersensiti"ity.

>.6o not use with other anticoagulants.

;./ote any history of !e!tic ulcer.

?.2e!ort signs of side effect e.g. gastric irritation if occurs.

A.+s!irin is not gi"en $ week before J after surgery to !re"ent bleeding.

D. If !atient is diabetic discuss the !ossibility of hy!oglycemia occurring Patients

should monitor their blood glucose le"el freuently.

B. *eaches !atient about the to3ic sym!toms

'ringing in the ears( di99iness mental confusionetc( and

ask himNher to re!ort it to !hysician.

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@

Y. L(8&QH8"# C7H$(oHl ,

U$H#" nHm",1ucarbon

L(8&on&adsorbents


+!"!&used as adsorbent in cases of organo!hos!hourous !oisoning

$0


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Ao!" ,the first dose of $00 g is gi"en with a la3ati"e

'1.g. magnesium sul!hate( followed by acti"ated

charcoal ?0 g e"ery ; hours 'or more freuently if

tolerated( until the charcoal is seen in the stool.

@$!&n% (on!"$H8&on!, 13!lain the !rocedure to !atient because it always gi"en "ia /%* es!ecially if the

!atient is conscious and you want to insert /%*

ear glo"es when dealing with this drug because the !owder form discolor e"ery

thing to black color when touching it

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Z. L#$"nHl&n" W 'K&n"K7$&n" T , VymKH87om&m"8&(!

U$H#" nHm",+drenalineClH!!&6irect actingadrenergic agent.

G$"%nHn(y,',ategory ,(L(8&on,

+ natural hormone !roduced from adrenal medulla- induce marked stimulation of al!ha $ )

rece!tors causing cardiac stimulation bronchodilation J decongestion.

+!"!,

$ 2elief of res!iratory distress due to bronchos!asm.

) 2a!id relief of hy!ersensiti"ity reactions.

> ,ardiac arrest.

; O!en angle glaucoma.

? *o !rolong the action of anesthesia.

A *o!ically to sto! bleeding.

Ao!",

+"ailable in am!oules of $ml containing $ mg adrenaline

,an be gi"en by I.4 inection. I.


13/168

is doubt as to the adeuacy of the circulation by slow intra"enous inection of $ in $0 000

'$00 microgramsNmL( solution 'e3treme caution(

Ao!",

I


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[. Llm&n&m 7y#$oX" Hn# mH%n"!&m 7y#$oX" ,

U$H#" nHm",WW LllmH%T

ClH!!&+ntacids

G$"%nHn(y,',ategory 5(

L(8&on&neutrali9ing or reducing gastric acidity thus increasing the !7 of the stomach and relie"ing

hy!eracidity. If the !7 is increased to ; the acti"ity of !e!sin is inhibited.

+!"!,

a. *reatment of hy!eracidity. '7eart burns(.b. Pe!tic ulcerc. 6uodenal ulcer.d. %astroeso!haged reflu3.e. hiatus hernia

Ao!"&$0 mL > or ; times daily of liuid magnesiumMaluminum antacids. +ntacids are best gi"en

when sym!toms occur or are e3!ected usually between meals and at

bedtime ; or more times daily- additional doses may be reuired u! to

once an hour.

Con8$H&n#&(H8&on!, Pregnancy

,hildren less than A years of age.

,hronic use of aluminum containing antacids may contribute to de"elo!ment of

+l9heimerKs disease.V" "II"(8!,

,onsti!ation intestinal obstruction bone !ain muscle weakness.

@$!&n% (on!"$H8&on!, It is recommended that most antacids be taken at > hours after meals J at bed M time.

*ablets should be thoroughly chewed before swallowing J followed by a glass of milk orwater.

Shake liuid sus!ensions thoroughly before !ouring the medication .

,lientKs taking aluminum or calcium containing antacids should take )?00>000 cc of fluids

to !re"ent consti!ation. +d"ise clients to re!ort !ersistent diarrhea or consti!ation !hysician.

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\. LlloK$&nol , ]ylo$&(

U$H#" nHm",Gyloric

ClH!!&+ntigout +gents


L(8&on,Is a !otent 3anthine o3idase inhibitor which reduces both serum and urinary uric acid

le"els by inhibiting the formation of uric acid without disru!ting the biosynthesis of "ital !urines.

$>
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+!"!,

Is the drug of choice for chronic gouty arthritis 'not useful for treatment of acutegout(.

7y!eruricemia associated with blood diseases renal diseases.

Pro!hylasis in hy!eruricemia in !atients with neo!lastic conditions.

*reatment of !atients with recurrent uric stone formation.

Ao!"

initially $00 mg daily !referably after food then adusted according

to !lasma or urinary uric acid concentration- usual maintenance dose in mild conditions $00M

)00 mg daily in moderately se"ere conditions >00MA00 mg daily in se"ere conditions D00MC00 mg

daily- doses o"er >00 mg daily gi"en in di"ided doses- ,7IL6 under $?years 'in neo!lastic

conditions en9yme disorders( $0M)0 mgNkg daily 'ma3. ;00 mg daily(

Con8$H&n#&(H8&on!, 7y!ersensiti"ity. Lactation.

7emochromatosis.

,hildren e3ce!t for those with neo!lastie diseases.V" "II"(8!,

Skin rash alo!ecia fe"er leuko!nea arthralgia nausea "omiting.@$!&n% (on!"$H8&on!,

+dminister with food or immediately after meal to lessen gastric irritation.

+t least $0$) eight ounce glasses of fluid should be taken each day.

ee! urine alkaline to !re"ent the formation of uric acid stones. *ake com!lete drug history.

4onitor the ,5, li"er J renal function J serum uric acid on routine bases.

If skin rash a!!ear re!ort to !hysician.

+"oid e3cessi"e intake of "itamin , which lead to the !otential for theformation of kidney stones.

+d"ice clients not to take iron salts with allo!urinol since high ironconcentration may occur in the li"er.

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^. Lm&_H(&n VlIH8",

U$H#" nHm",amikin

ClH!!&+ntibiotic F+mino glycosidesF

G$"%nHn(y,',ategory ,(L(8&on,inhibit !rotein synthesis by binding irre"ersibly to ribosome which leads to !roduction of

nonfunctional !rotein. *hey are usually bactericidal as a result of disru!tion of bacterial

cyto!lasmic membrane.

+!"!, 5one and oint infections.

2es!iratory tract infections.

$;


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Se!ticemia 'including neonatal se!sis(.

Urinary tract infection 'UI*(.

Post o!erati"e infections.

Intra Mabdominal infections 'as !eritonitis( .

Skin infections 'including burns(

Ao!" & by intramuscular or by slow intra"enous inection or by infusion $? mgNkg daily

in ) di"ided doses increased to )).? mgNkg daily in > di"ided doses in se"ere infections-

ma3. $.? g daily for u! to $0 days 'ma3. cumulati"e dose $? g(- child $? mgNkg daily in )

di"ided doses- neonate loading dose of $0 mgNkg then $? mgNkg daily in ) di"ided doses.

Con8$H&n#&(H8&on!, 7y!ersensiti"ity to amino glycosides.

Long Mterm thera!y.

8or !atients with im!aired renal function or !ree3isting hearing im!airment.

V" "II"(8!,

Ototo3icity& tinnitus hearing im!airment ata3ia J di99iness.

2enal im!airment '/e!hroto3icity( hematuria !roteinuriaR

/euroto3icity& headache tremor lethargy numbness burning of face.

Others& nausea "omiting skin rash J su!er infection.

@$!&n% (on!"$H8&on!, I.4. admin. Inect dee! into muscle to minimi9e !ain.

+dmin. 8or only D$0 days. +ssess history of hy!ersensiti"ity.

Obtain lab. Studies for renal function.

,ontinue to monitor for ototo3icity.

6iscuss with the client N family the im!ortance of taking medications at thea!!ro!riate !rescribed time inter"als.

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F. Lm&noK7yll&n",

ClH!!&+ntiasthmatic bronchodilator

G$"%nHn(y,',ategory ,(L(8&on&2ela3es smooth muscles of bronchi causing bronchodilation and increasing "ital ca!acity

of the lungs

+!"!,

Pro!hyla3is and treatment of bronchial asthma.

2e"ersible bronchos!asm associated with ,.O.P.6.

Ao!" ,

5y mouth$00M>00 mg >M; times daily after food

$?


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slow intra"enous inection&o"er at least )0 minutesF not !re"iously treated with

theo!hyllineF 'with close monitoring( '? mgNkg(

Intra"enous infusion& 0.> M 0.D mgNkgNhour

Con8$H&n#&(H8&on!, 7y!ersensiti"ity

7y!otension

,oronary artery disease 'angina !ectoris(.

V" "II"(8!,

/ausea "omiting e!igastric !ain.

2ectal irritation following use of su!!ositories.

7eadache di99iness 7y!otension arrhythmias ' tachycardia(

+mino!hylline gi"en by ra!id I. of the

cardiac action !otential. It has numerous other effects howe"er including actions that are similar to

those of antiarrhythmic classes I II and I times daily for $ week reduced to )00 mg twice daily for a

further week- maintenance usually )00 mg daily or the minimum reuired to control the

arrhythmia

by intra"enous infusion&initially ? mgNkg o"er )0M$)0 minutes with 1,% monitoring-

$A


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subseuent infusion gi"en if necessary according to res!onse u! to ma3. $.) g in ); hours FC00 mg

o"er )> hours E.

Q(-

erythema multiform e3foliati"e dermatitis !ruritus skin cancer Ste"ens

ohnson syndrome to3ic e!idermal necrolysis "asculitis '!ostmarketing(.

11/*

Q(.

%I

/ausea "omiting '$0Q to >>Q(- anore3ia consti!ation ';Q to

CQ(- abdominal !ain abnormal sali"ation abnormal taste '$Q to

>Q(- !ancreatitis '!ostmarketing(.

@$!&n% (on!"$H8&on!,

6uring I< infusion carefully monitor blood !ressure and

Slow the infusion if significant hy!otension occurs.

$D


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5radycardia should be treated by slowing the infusion or discontinuing it if

necessary. Sustained monitoring is essential because drug has an unusually long

halflife.

2e!ort ad"erse reactions !rom!tly. 5ear in mind that long

1limination halflife means that drug effects will !ersist long

after dosage adustments are made or drug is discontinued.

5e alert to signs of !ulmonary to3icity& !rogressi"e dys!nea

fatigue cough !leuritic !ain fe"er.

+uscultate chest !eriodically or when !atient com!lains of

res!iratory sym!toms. ,heck for diminished breath sounds rales !leuritic friction

rub- obser"e breathing !attern. 6rug induced !ulmonary function !roblems must be

distinguished from ,78 or !neumonia. ee! your medical direction !hysician

informed.

4onitor heart rate and rhythm and 5P until drug res!onse

has stabili9ed. 2e!ort !rom!tly sym!tomatic bradycardia.

Patients already recei"ing antidysrhythmic thera!y when

+miodarone is started must be closely obser"ed for ad"erse

effects !articularly conduction disturbances and e3acerbation of dysrhythmias.

6osage of !re"ious agent should be

reduced by >0T?0Q se"eral days after amiodarone thera!y is started

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O

SE. LmK&(&ll&n,

U$H#" nHm",Penbritin

ClH!!& +ntibiotic F5roads!ectrum !enicillinE


L(8&on,Inhibit cell wall synthesis some act by binding to !enicillin binding !rotein in the

cyto!lasmic membrane of the bacteria.

+!"!,

2es!iratory urinary J %I tract infections J other infection due to

am!icillin sensiti"e organisms.

4eningitis caused by /eisseria meningitidis.

Ao!"

$B


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5y mouth0.)?M$ g e"ery A hours at least >0 minutes before food-

,7IL6 under $0 years half adult dose.

Urinarytract infections?00 mg e"ery B hours-

,7IL6 under $0 years half adult dose.

5y intramuscular inection or intra"enous inection or infusion ?00 mg e"ery ;MAhours- ,7IL6 under $0 years half adult dose

Listerial meningitis 'in combination with another antibiotic( by

intra"enous infusion ) g e"ery ; hours for $0M$; days- I/8+/* under $

month ?0 mgNkg e"ery A hours- $M> months ?0M$00 mgNkg e"ery A hours-

child > monthsM$) years $00 mgNkg e"ery A hours 'ma3. $) g daily(

Con8$H&n#&(H8&on!,

7y!ersensiti"ity to !enicillins. Use cautiously with renal disorders.

V" "II"(8!,

+llergic& skin rashes !ruritis whee9ing fe"erR. .

6iarrhea abdominal cram! !ain nausea "omiting.

Psendomembranous colitis thrombocyto!enia leuko!nea

*hrombo!hlebitis 1lectrolytes imbalance following I.? minutes or by infusion.

I.4. inections are made dee!ly into the gluteal muscle.

+ssess regularly for allergic reactions. If reaction occurs the drug must be discontinued

immediately 1!ine!hrine O)K antihistamines corticosteroids must be immediately

a"ailable.

6etain client in an ambulatory care site for at least )0 min after administering Penicillin.

+fter inection because rate of absor!tion should not be increased.

,om!lete entire !rescribed course of thera!y.

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@

SS. LmK7o8"$(&n,

$C


21/168

U$H#" nHm",+m!hocin 8ungi9one

ClH!!&+ntibiotic antifungal


L(8&on,am!hotericin associates with ergosterol a membrane chemical of fungi forming a !ore

that leads to leakage and fungal cell death

+!"!,

+ntifungal infection

Ao!" , by mouth intestinal candidiasis $00M)00 mg e"ery A hours- Infant and child $00 mg

; times daily

Pro!hyla3is /eonate $00 mg once daily

My &n8$HQ"no! &nI!&on systemic fungal infections initial test dose of $ mg o"er )0M>0

minutes then )?0 microgramsNkg daily gradually increased if tolerated to $ mgNkg daily- ma3.

'se"ere infection( $.? mgNkg daily or on alternate days

Con8$H&n#&(H8&on!,+llergic reaction to am!hotericin

V" "II"(8!,

5urning itching redness or other sign of irritation not !resent before use of

this medicine Skin rash 6ryness of skin.

/ausea "omiting diarrhea melena abd. ,ram!s.

8e"er headache thrombo!hlebitis bone marrow de!ression !ancyto!nea.

+na!hyla3is.

@$!&n% (on!"$H8&on!,

*he drug is to3ic and should be used only for !atients under close medical su!er"ision

with a relati"ely certain diagnosis of dee! mycotic infections.

I.


22/168

+!"!,

7y!ertension.

+ngina !ectoris.

Ao!"&by mouth 7y!ertension ?0 mg daily 'higher doses rarely necessary(

+ngina$00 mg daily in $ or ) doses

+rrhythmias?0M$00 mg daily

5y intra"enous inectionarrhythmias ).? mg at a rate of

$ mgNminute re!eated at ?minute inter"als to a ma3. Of $0 mg

Con8$H&n#&(H8&on!,

5radycardia ,.7.8. cardiogenic shock diabetes thyroto3icosis chronic bronchitis

asthma bronchos!asm em!hysema.

V" "II"(8!,

5radycardia ,.7.8. hy!otension cold e3tremities 'due to !eri!heral "asoconstriction(

edema dys!nia shortness of breath nausea "omiting he!atomegaly and

bronchos!asm.

@$!&n% (on!"$H8&on!,

8or I< use the drug may be diluted in sodium chloride de3trose on de3trose saline.

Instruct !atientNfamily to take blood !ressure and !ulse.

Pro"ide written instructions as when to call !hysician 'e.g. 72 below ?0 beatNmin(.

Instruct !atient to dress warmly during cold weather.

6iabetic !atient should be "ery careful about sym!toms of hy!oglycemia.

2e!ort any asthmalike sym!toms.

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOSY. L8o$QH!8H8&n,

U$H#" nHm",Li!itor

ClH!!&+ntihy!erli!idemic Statins

G$"%nHn(y,',ategory V(

L(8&on,lowers the le"el of cholesterol in the blood by reducing the !roduction of cholesterol

by the li"er.

+!"!,

Pre"enting and treating atherosclerosis.

Ao!"

)$


23/168

Primary hy!ercholesterolemia and combined hy!erli!idaemia usually

$0 mg once daily

8amilial hy!ercholesterolemia initially $0 mg daily increased at

inter"als of at least ; weeks to ;0 mg once daily- if necessary further

increased to ma3. B0 mg once daily

Con8$H&n#&(H8&on!,

+llergy to ator"astatin fungal by!roducts acti"e li"er disease or une3!lained and

!ersistent ele"ations of transaminase le"els !regnancy lactation.

Use cautiously with im!aired endocrine function

V" "II"(8!, ,/S&7eadache asthenia

%I&8latulence abdominal !ain cram!s consti!ation nausea dys!e!sia

heartburn li"er failure

2es!iratory&Sinusitis !haryngitis.

Other&2habdomyolysis with acute renal failure arthralgia myalgia

@$!&n% (on!"$H8&on!,

Obtain li"er function tests as a baseline and !eriodically during thera!y.

ithhold ator"astatin in any acute serious condition 'se"ere infection hy!otension maor

surgery trauma se"ere metabolic or endocrine disorder sei9ures(

1nsure that !atient has tried cholesterollowering diet regimen for >A mo before

beginning thera!y.

+dminister drug without regard to food but at same time each day.

,onsult dietitian regarding lowcholesterol diets.

1nsure that !atient is not !regnant and has a!!ro!riate contrace!ti"es a"ailable during

thera!y- serious fetal damage has been associated with this drug.

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

SZ. L8$H($&m,

U$H#" nHm",U$H($&m


L(8&on,muscle rela3ant

+!"!,

))


24/168

It is used as an adunct to general anesthesia or sedation in the intensi"e care unit

'I,U( to rela3 skeletal muscles and to facilitate tracheal intubations and mechanical

"entilation.

Ao!" , intra"enous inection& 0.>M0.A mgNkg

4aintenanceF intra"enous infusionF '0.>M0.A mgNkg hour(

Con8$H&n#&(H8&on!,

7y!ersensiti"e to atracurium cisatracurium or ben9enesulfonic acid.

V" "II"(8!,

Skin flushing mild reduction in blood !ressure and difficulty in breathing.


25/168

6uring anesthesia to control sali"ation J bronchial secretions.

Parkinsonism.

+ntiarrhythmic '!ro!hyla3is(.

Pro!hyla3is and treatment of to3icity due to cholinesterase inhibitor including

organo!hos!hate !esticides.

O!hthalmologic treatment of u"eitis.

Ao!"

5radydysrhythmia &+dult 0.?$ mg I< may re!eated at ? min inter"als

until desired rate achie"ed F ma3 0.0> 0.0; mg N kg F Pediatric 0.0) mgNkg F min dose 0.$

mg ma3 single dose 0.? mg for a child and $ mg for an

adolescent.

+systole J P1+&+dult $ mg I< may re!eated e"ery >? min Fma3

0.0> 0.0; mg N kg com!lete "agal blockF

Pediatric unknown efficacy.

1ndotracheal route&>0 micNkg diluted in ? ml /S

+nticholinesterase !oisoning& +dult$) mg !ush e"ery ?$?

minutes to dry secretions no ma3 dose

Pediatric 0.0? mgNkgNdose e"ery ?$? min

@M

Possible !arado3ical bradycardia when !ushed slowly or when used at

doses less than 0.? mg

Con8$H&n#&(H8&on!,

%laucoma tachycardia myocardial ischemia.

Prostate hy!ertro!hy myasthenia gra"is !aralytic ileus.

4ental im!airment lactation he!atic disease.

V" "II"(8!,

/ausea "omiting dry mouth consti!ation heartburn

di99iness drowsiness headache insomnia blurring of "ision

Photo!hobia flashing eu!horia hallucination flushing of the skin.

@$!&n% (on!"$H8&on!,

,heck dosage J measure the drug e3actly.

+ssess for history of asthma glaucoma ulcer... etc.

6etermine the age of the client.

);


26/168

8reuent mouth care.

+ssess client for change in !ulse rate.

In case of blurring of "ision assist on ambulating J gi"e safety measures.

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

S\. M&!oK$olol ImH$H8",

U$H#" nHm",Gebeta

ClH!!&5etaadrenoce!tor blocking drugs


L(8&on&

5locks adrenergic rece!tors of the sym!athetic ner"ous system in the heart and

u3taglomerular a!!aratus 'kidney( thus decreasing the e3citability of the heart. 6ecreasing cardiac out!ut and o3ygen consum!tion decreasing the release of rennin

from the kidney and lowering blood !ressure.

+!"!,

4anagement of hy!ertension

used alone or with otherantihy!ertensi"e agents

Ao!"

Hypertension and anginausually $0 mg once daily '? mg may beadeuate in some !atients(- ma3. )0 mg daily

Adjunct in stable moderate to severe heart failureinitially $.)? mg once

daily 'in the morning( for $ week then if well tolerated increased to

).? mg once daily for $ week then >.D? mg once daily for $ week then ? mg

once daily for ; weeks then D.? mg once daily for ; weeks then $0 mg

once daily- ma3. $0 mg daily

Con8$H&n#&(H8&on!,

Sinus bradycardia second or thirddegree heartblock cardiogenic shock ,78.

Use cautiously with renal failure diabetes or thyroto3icosis 'biso!rolol can mask the

usual cardiac signs of hy!oglycemia and thyroto3icosis( lactation.

V" "II"(8!,

,/S&6i99iness !aresthesias slee! disturbances hallucinations disorientation

memory loss slurred s!eech .

%I&%astric !ain flatulence consti!ation diarrhea nausea "omiting anore3iaischemic colitis retro!eritoneal fibrosis he!atomegaly acute !ancreatitis.

)?


27/168

,


28/168

2enal failure

7y!o!arathyroidism.

Premature infants.

*o treat de!letion of electrolytes.

6uring cardiac resuscitation.

@ I.4. or I.


29/168

@$!&n% (on!"$H8&on!,

Oral&

administer $$.? hr after meals alkalis J large amounts of fat

decrease the absor!tion of calcium.

If the client has difficulty swallowing large tablets obtain a calcium in water

sus!ension by diluting the calcium in hot water then cooled by administration.

I.


30/168

Heart failure'adunct( initially A.)?M$).? mg under close medical su!er"ision-

usual maintenance dose )? mg )M> times daily- usual ma3. $?0 mg daily

Prophylaxisafter infarctionin clinically stable !atients with asym!tomatic

or sym!tomatic left "entricular dysfunction initially A.)? mg starting as early as > days after

infarction then increased o"er se"eral weeks to $?0 mg daily 'if tolerated( in di"ided doses .Con8$H&n#&(H8&on!,

7y!ersensiti"ity 2eno "ascular disease and !regnancy.

V" "II"(8!,

Skin rash loss of taste neutro!nea nausea "omiting

7y!otension !roteinuria renal failure and hy!erkalemia.

@$!&n% (on!"$H8&on!,

In case of o"erdose gi"e normal saline to restore 5P.

Should not be discontinued without 6r. Instructions.

Obtain baseline hematological studies li"er J renal functions tests !rior to

beginning the treatment.

6etermine client understands of the thera!y and if heNshe takes other medications.

Obser"e client closely for hy!otension > hours after the initial dose.

In case of hy!otension !lace client in su!ine !osition and gi"e I< saline infusion.

ithhold !otassium s!aring diuretics and consult with !hysician 'hy!erkalemia

may occur(.

*ake ca!to!ril $ hour before meal or on an em!ty stomach.

2e!ort skin rash heartburn and chest !ain to !hysician.

13!lain to client that he may de"elo! loss of taste for )> months if it !ersists

notify the !hysician.

S`. CH$Q"#&lol,

U$H#" nHm",,orega 6ilatrend.

ClH!!&antihy!ertensi"e,beta blockers.


L(8&on,

)C


31/168

5locks stimulation of beta$ 'myocardial( and beta) '!ulmonary "ascular and

uterine( adrenergic rece!tor sites

+lso has al!ha$ blocking acti"ity which may result in orthostatic hy!otension.

+!"!, 4anagement of hy!ertension.

4anagement of ,78 'due to ischemia or cardiomyo!athy( with digo3in

diuretics and +,1 inhibitors.

Ao!"

7y!ertensioninitially $).? mg once daily increased after ) days to usual dose of )? mg

once daily- if necessary may be further increased at inter"als of at least ) weeks to ma3.

?0 mg daily in single or di"ided doses; ELDEL!initial dose of $).? mg daily may !ro"idesatisfactory control +nginainitially $).? mg twice daily increased after ) days to )? mg

twice daily

+dunct in heart failureinitially >.$)? mg twice daily 'with food( dose increased at

inter"als of at least ) weeks to A.)? mg twice daily then to $).? mg twice daily then to

)? mg twice daily- increase to highest dose tolerated ma3. )? mg twice daily in !atients

with se"ere heart failureor bodyweight less than B? kg and ?0 mgtwice daily in !atients

o"er B? kg

Con8$H&n#&(H8&on!,

Uncom!ensated ,78.

Pulmonary edema.

,ardiogenic shock.

5radycardia or heart block.

Se"ere he!atic im!airment or bronchial asthmaNbronchos!asm.

V" "II"(8!, ,ar"edilol may cause hy!erglycemia tiredness weakness

lightheadedness di99iness headache

diarrhea nausea "omiting "ision changes oint !ain difficulty falling

aslee! or staying aslee!

,ough dry eyes numbness burning or tingling in the arms or legs

@$!&n% (on!"$H8&on!, *each !atient and family how to check !ulse and blood !ressure.

>0


32/168

4ay cause drowsiness or di99iness. ,aution !atients to a"oid dri"ing or other

acti"ities that reuire alertness until res!onse to the drug is known.

Patients with diabetes should closely monitor blood sugar

+d"ise !atient to notify health care !rofessional if slow !ulse difficulty breathing

whee9ing cold hands and feet di99iness confusion de!ression rash fe"er sore

throat unusual bleeding or bruising occurs.

7y!ertension& 2einforce the need to continue additional thera!ies for hy!ertension

'weight loss sodium restriction stress reduction regular e3ercise moderation of

alcohol consum!tion and smoking cessation(.

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

O

DE. C"IHbol&n,

U$H#" nHm",+ncef ef9ol.

ClH!!&+ntibiotic Fce!halos!orinesF8I2S* %1/12+*IO/


L(8&on,5ind to bacterial cell wall membrane causing cell death.

+!"!,*reatment of&

Skin and skin structure infections 'including burn wounds(

Pneumonia.

Otitis media.

Urinary tract infections.

5one and oint infections.

Se!ticemia 'including endocarditic( caused by susce!tible organisms.

Perio!erati"e !ro!hyla3is.

Ao!"

5y intramuscular inection or intra"enous inection or infusion 0.?M$ g e"ery AM$)

hours- ,7IL6 )?M?0 mgNkg daily 'in di"ided doses( increased to $00 mgNkg daily in se"ere

infections

Con8$H&n#&(H8&on!,

7y!ersensiti"ity to ce!halos!orin or Penicillin renal failure Pregnancy Lactation.

>$


33/168


34/168

Con8$H&n#&(H8&on!,

7y!ersensiti"ity to ce!halos!orin or Penicillin.

V" "II"(8!,

,/S&sei9ures 'high doses(.

%I&!seudomembraneous colitis diarrhea nausea "omiting cram!s

!seudolithiasis 'ceftria3one(.

6erm&rashes urticaria.

7emat&bleeding 'increased with cefo!era9one( blood dyscrasias hemolytic

anemia.

Local&!ain at I4 site !hlebitis at I< site.

4isc&allergic reactions including ana!hyla3is and serum sickness su!er infection.

@$!&n% (on!"$H8&on!, Should not be mi3ed with amino glycosides. ' each should be gi"en se!arately(

8or I.di"ided doses- intra"enousroute recommended for children

>>


35/168

Surgical !ro!hyla3is !rostatic surgery $ g at induction of anesthesia re!eated if necessary

when catheter remo"ed

Con8$H&n#&(H8&on!,

7y!ersensiti"ity to ce!halos!orin

V" "II"(8!,

6iarrhea stomach !ain u!set stomach "omiting.

@$!&n% (on!"$H8&on!,

Infuse o"er >0 minutes unless otherwise indicated.

*hera!y should be continued for at least )> days after sym!toms of infection ha"e

disa!!eared.

+ssess client with a history of hy!ersensiti"ity reaction. for !enicillin or

ce!halos!orin.#

+ssess client financial status. *hese drugs are usually e3!ensi"e.

Obtain li"er J renal studies.

DY. C"I8$&HXon",

U$H#" nHm",2oce!hin

ClH!!& +ntibiotic Fce!halos!orinesF third"generation


L(8&on,5ind to bacterial cell wall membrane causing cell death.

+!"!,

Pneumonia U*I infections of skin bone J abdomen. 4eningitis bacterial

se!ticemia !reo!. !ro!hyla3is.

Ao!"by dee! intramuscular inection or by intra"enous inection o"er at least )M; minutes or by

intra"enous infusion $ g daily- )M; g daily in se"ere infections- intramuscular doses o"er

$ g di"ided between more than one site /eonateby intra"enous infusion o"er A0 minutes

)0M?0 mgNkg daily 'ma3. ?0 mgNkg daily( Infant and childunder ?0 kg by dee!

intramuscular inection or by intra"enous inection o"er )M; minutes or by intra"enous

infusion )0M?0 mgNkg daily- u! to B0 mgNkg daily in se"ere infections- doses of ?0 mgNkg

and o"er by intra"enous infusion only- ?0 kg and o"er adult doseUncom!licated gonorrhea by dee! intramuscular inection )?0 mg as a single dose.

>;


36/168

Surgical !ro!hyla3is by dee! intramuscular inection or by intra"enous

inection o"er at least )M; minutes $ g at induction- colorectal surgery by dee!

intramuscular inection or by intra"enous inection o"er at least )M; minutes or by

intra"enous infusion ) g at induction- intramuscular doses o"er $ g di"ided between morethan one site

Con8$H&n#&(H8&on!,

7y!ersensiti"ity to ce!halos!orin or Penicillin renal failure

V" "II"(8!,

/ausea "omiting diarrhea anore3ia abdominal !ain flatulence skin rashes

su!erinfection heartburn sore mouth bone marrow de!ression.

@$!&n% (on!"$H8&on!, I.4. inection should be dee! into the body of large muscle.

I.


37/168


38/168

D[. C7lo$HmK7"n&(ol ,

U$H#" nHm",,hloromycetin

ClH!!& antibiotic


L(8&on&it inhibits !rotein synthesis in bacteria by binding to ribosome.

+!"!,

/ot to be used for tri"ial infections as !ro!hyla3is of infection

,old throat infections or flu.

*reatment of choice for ty!hoid fe"er 'not for carrier state(.

4eningitis due to hemo!hilus influen9a !neumocoeoi or

4iningococei.

Skin infections 'to!ically(.

5rain abscesses.

Ao!" & by mouth or by intra"enous inection or infusion ?0 mgNkg daily in ; di"ided

doses 'e3ce!tionally can be doubled for se"ere infections such as se!ticemia and

meningitis !ro"iding high doses reduced as soon as clinically indicated(- ,hild

haemo!hilus e!iglottitis and !yogenic meningitis ?0M$00 mgNkg daily in di"ided doses

'high dosages decreased as soon as clinically indicated(- Infants under ) weeks)? mgNkg

daily 'in ; di"ided doses(

) weeksM$ year?0 mgNkg daily 'in ; di"ided doses(

Con8$H&n#&(H8&on!,

7y!ersensiti"ity to chloram!henicol.

Pregnancy

/ursing mothers.

2enal and he!atic failure.V" "II"(8!,

+ !lastic anemia !ancyto!nea nausea "omiting abdominal distention !rogressi"e !allid

cyanoses ashen gray color tachy!nea "asomotor colla!se J death# %ray syndrome in

infants su!er infections.

@$!&n% (on!"$H8&on!,

+dminister I.D


39/168


40/168

Patients with history of sei9ures J on anticon"ulsant thera!y.

7e!atic J renal diseases.

Prostatic hy!ertro!hy.

6ehydration glaucoma measles.

V" "II"(8!,

6e!ression di99iness sei9ures gynecomastia. Orthostatic hy!otension bronchos!asm

larlynyos!asm tardi"e dyskinesia !hotosensiti"ity leuko!nea a!lastic anemia and dry

mouth.

@$!&n% (on!"$H8&on!,

ShouldnKt be used to treat nausea J "omiting in children less than A months of age.

Should a"oid getting solution on hands or clothing 'it will cause dermatitis(.

Solutions with marked discoloration should be discarded.

/ote any history of sei9ures.

*ake li"er J kidney function test !eriodically.

6ocument J rotate inection sites.

2e!ort side effects immediately.

6etermine age of male !atients J assess for !rostatic hy!ertro!hy.

@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

D^. C&K$oIloXH(&n cy#$o(7lo$",

U$H#" nHm",ci!ro3in

ClH!!&+ntibacterial uinolone deri"ati"e


L(8&on,is a synthetic uinolone with broad s!ectrum bactericidal acti"ity inhibits the

synthesis of bacterial 6/+ by inhibiting the en9yme 6/+ gyrase.

+!"!,

UI* infectious diarrhea

Infection of lower res!iratory tract bone oints J skin.

Ao!" , by mouth res!iratorytract infections )?0MD?0 mg

*wice daily Urinarytract infections )?0M?00 mg twice

6aily '$00 mg twice daily for > days in acute

>C


41/168

uncom!licated cystitis in women(

,hronic !rostatitis ?00 mg twice daily for )B days

%onorrhea?00 mg as a single dose

Pseudomonal lower res!iratorytract infectionin cystic fibrosis D?0 mg twice

daily- ,7IL6 ?M$D years u! to )0 mgNkg twice daily 'ma3. $.? g daily(4ost other infections ?00MD?0 mg twice daily

Surgical !ro!hyla3is D?0 mg A0MC0 minutes before !rocedure

Pro!hyla3is of meningococcal meningitis Wnot licensed for this indicationX

?00 mg as a single dose- ,hild ?M$)years )?0 mg

5y intra"enous infusion 'o"er >0MA0 minutes- ;00 mg o"er A0 minutes( )00M

;00 mg twice daily ,hild )0 mgNkg daily in ) di"ided doses

Pseudomonal lower res!iratorytract infection in cystic fibrosis ;00 mg twicedaily- ,7IL6 ?M$D years u! to $0 mgNkg > times daily 'ma3. $.) g daily(

,hild not recommendedbut where benefit outweighs risk by mouth $0M>0 mgNkg

daily in ) di"ided doses or by intra"enous infusion BM$A mgNkg daily in ) di"ided

doses

+nthra3'treatment and !oste3!osure !ro!hyla3is see notes abo"e( by mouth

?00 mg twice daily- child >0 mgNkg daily in ) di"ided doses 'ma3. $g daily(

Con8$H&n#&(H8&on!,

7y!ersensiti"ity children lactation.

V" "II"(8!,

/ausea "omiting. 6ys!hasia crystalluria

7ematuria 2ashes bad taste %I bleeding

7eadache insomnia.

@$!&n% (on!"$H8&on!,

%i"e medication ) hr after meals.

Stress im!ortance of drinking increased amounts of fluids to kee! urine acidic J to

minimi9e the risk of crystalluria.

@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

DF. Cl&n#Hmy(&n K7o!K7H8",

U$H#" nHm",6alacin

ClH!!&antibiotic clindamycin


;0


42/168

L(8&on,su!!ress !rotein synthesis by microorganisms by binding to ribosomes. It is both

bacteriostatic J bactericidal.

+!"!,

Serious res!iratory tract infections. 'lung abscess !neumonia(.

Serious skin infections.

Se!ticemia.

Osteomyelitis caused by sta!hylococci.

Used to!ically for inflammatory acne "ulgaris .

Ao!" & by mouth $?0M>00 mg e"ery A hours- u! to ;?0 mg e"ery A hours in se"ere infections-

,7IL6 >MA mgNkg e"ery A hours

/.5

Patients should discontinue immediately and contact doctor if diarrhea de"elo!s- ca!sules should

be swallowed with a glass of water.

5y dee! intramuscular inection or by intra"enous infusion 0.AM).D g daily 'in )M; di"ided

doses(- lifethreatening infection u! to ;.B g daily- single doses abo"e A00 mg by intra"enous

infusion only- single doses by intra"enous infusion not to e3ceed $.) g

,7IL6 o"er $ month $?M;0 mgNkg daily in >M; di"ided doses- se"ere infections at least

>00 mg daily regardless of weight.

Con8$H&n#&(H8&on!,

7y!ersensiti"ity

4inor bacterial infections.

Pregnancy.

V" "II"(8!,

/ausea "omiting diarrhea abdominal !ain tenesmus.

Loss of weight !seudo membranous colitis skin rashes.

7y!otension.

*hrombo!hlebitis following I.


43/168

5e !re!ared to manage colitis which can occur )C days or se"eral weeks after initiation of

thera!y. hich includes& fluids electrolytes Protein su!!lement corticosteroids and


44/168

+llergic& skin rashes !ruritis whee9ing fe"erR. .

6iarrhea abdominal cram!s !ain nausea "omiting.

Psendomembranous colitis thrombocyto!enia leuco!enia

*hrombo!hlebitis 1lectrolytes imbalance following I.


45/168


46/168


47/168

4uscle rela3ant.

+nticon"ulsi"e.

Preo!erati"ely.

5efore gastresco!y or eso!hagosco!y.

*reatment of status e!ile!ticus.

2elief of facial muscle s!asm.

Ao!"

5y intra"enous inection $0M)0 mg at a rate of 0.? mL ').? mg( !er >0 seconds re!eated

if necessary after >0MA0 minutes- may be followedby intra"enous infusionto ma3.

> mgNkg o"er ); hours-

,hild0.)0.> mgNkg or $ mg !er year of age

by rectum as rectal solution +dult and ,hildo"er $0 kg 0.? mgNkg- 1lderly0.)?mgNkg

Con8$H&n#&(H8&on!,

7y!ersensiti"ity.

+cute narrow angle glaucoma.

Pregnancy.

Shock coma.

+lcoholic into3ication 'to a"oid res!iratory of de!ression(.

V" "II"(8!,

6rowsiness fatigue

ata3ia

hy!otension

"isual disturbances headache

Phlebitis at inection site.

@$!&n% (on!"$H8&on!,

Stress that drug may reduce !tKs ability to handle dangerous eui!ment.

+"oid alcohol ingestion.

6onKt sto! taking the medication suddenly withdraw drug gradually.

4onitor 5.P. before J after administration.

@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

YD. A&(loI"nH( Vo#&m,

U$H#" nHm"&6iclofenac sodium&


48/168

',+/(


49/168

) Lactation.

> 7y!ersensiti"ity 'asthma rashes rhinitis(.

; Uses with caution in !atients with a history of %I disease J reduced renal

functions.

V" "II"(8!, ,/S&7eadache di99iness somnolence insomnia fatigue tiredness

di99iness tinnitus o!hthalmologic effects

%I&/ausea dys!e!sia %I !ain diarrhea "omiting consti!ation flatulence

7ematologic&5leeding !latelet inhibition with higher doses

%U& 6ysuria renal im!airment

6ermatologic& 2ash !ruritus sweating dry mucous membranes stomatitis

Other&Peri!heral edema ana!hylactoid reactions to fatal ana!hylactic shock

@$!&n% (on!"$H8&on!,

%i"e on full stomach to a"oid %I* irritation.

hen gi"en I4 %i"e it dee! into a large muscle because drug is "ery irritant.

/ote any history of allergic res!onses to as!irin or nonsteroidal antiinflammatory

agents. Y/S.+I6.Z

/ote the age of the client.

6etermine if !atient is taking oral hy!oglycemic or insulin and document it.

*ake these agents with milk or meal or antacids as !rescribed.

1ncourage !atient to take drug regularly.

2e!ort signs of %I irritation sore throat fe"er rash itching weight gain swelling

in ankles or fingers changes in "ision- black tarry stools tinnitus and rashes M etc.

6i99iness drowsiness can occur 'a"oid dri"ing or using dangerous machinery while

on this drug(.

If the client has 6iabetes 4ellitus e3!lain the !ossible in increasing hy!oglycemic

effect of the drugs to test urine J blood for glucose. *o adust dose of these agents.

@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

YY. A&%oX&n ,

U$H#" nHm"& Lano3ica!s Lano3in /o"o6igo3in ',+/(

A$% (lH!!"!,

,ardiac glycoside

,ardiotonic agent

;B


50/168


U7"$HK"8&( H(8&on!

Increases intracellular calcium and allows more calcium to enter the myocardial cell during

de!olari9ation "ia a sodium!otassium !um! mechanism- this increases force of contraction

'!ositi"e inotro!ic effect( increases renal !erfusion 'seen as diuretic effect in !atients with

,78( decreases heart rate 'negati"e chronotro!ic effect( and decreases +< node conduction

"elocity.

*n#&(H8&on!

,78

+trial fibrillation

+trial flutter

Paro3ysmal atrial tachycardia

Ao!"

by mouth ra!id digitali9ation $M$.? mg in di"ided doses o"er ); hours- less urgent

digitali9ation )?0M?00 micrograms daily 'higher dose may be di"ided( 4aintenance

A).?M?00 micrograms daily 'higher dose may be di"ided( according to renal function and

in atrial fibrillation on heartrate res!onse- usual range $)?M)?0 micrograms daily

'lower dose may be a!!ro!riate in elderly(

1mergency loading doseby intra"enous infusion 0.D?M$ mg o"er at least ) hours then

maintenance doseby mouthon the following day

Con8$H&n#&(H8&on!,

,ontraindications& allergy to digitalis !re!arations "entricular tachycardia "entricular

fibrillation heart block sick sinus syndrome I7SS acute 4I renal insufficiency and

electrolyte abnormalities 'decreased decreased 4g increased ,a(.

Use cautiously with !regnancy and lactation.

V" "II"(8!,

,/S& 7eadache weakness drowsiness "isual disturbances

%I& %I u!set anore3ia

,


51/168

4onitor a!ical !ulse for $ min before administering- hold dose if !ulse [A0 in adult or [C0

in infant retake !ulse in $ h. If adult !ulse remains [A0 or infant [C0 hold drug and notify

!rescriber. /ote any change from baseline rhythm or rate.

,heck dosage and !re!aration carefully.

+"oid I4 inections which may be "ery !ainful.

8ollow diluting instructions carefully and use diluted solution !rom!tly.

+"oid gi"ing with meals- this will delay absor!tion.

7a"e emergency eui!ment ready- ha"e salts lidocaine !henytoin atro!ine and

cardiac monitor on standby in case to3icity de"elo!s.

4onitor for thera!eutic drug le"els& 0.?) ngNmL.

@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

YZ. AH&l8&Hb"m 7y#$o(7lo$" , U$H#" nHm"& +lti6iltia9em +!o6iltia9 ,ardi9em 6ilacor V2

%en6iltia9em /o"o6ilta9em /u6iltia9 *iamate *ia9ac

A$% (lH!!"!

,alcium channelblocker

+ntianginal agent

+ntihy!ertensi"e


L(8&on,,alciumchannel blockers Fanti anginal antihy!ertensi"eF

Inhibits the mo"ement of calcium ions across the membranes of cardiac and arterial muscle

cells resulting in the de!ression of im!ulse formation in s!eciali9ed cardiac !acemaker

cells slowing of the "elocity of conduction of the cardiac im!ulse de!ression of

myocardial contractility and dilation of coronary arteries and arterioles and !eri!heralarterioles- these effects lead to decreased cardiac work decreased cardiac energy

consum!tion and in !atients with "asos!astic 'Prin9metalEs( angina increased deli"ery of

o3ygen to myocardial cells.

*n#&(H8&on!

+ngina !ectoris due to coronary artery s!asm 'Prin9metalEs "ariant angina(

1ffortassociated angina- chronic stable angina in !atients not controlled by

adrenergic blockers nitrates

1ssential hy!ertension 'sustained release(

?0


52/168

*reatment of hy!ertension 'sustained release *iamate(

Paro3ysmal su!ra"entricular tachycardia '!arenteral(

Ao!"

+"ailable 8orms& *ablets>0 A0 C0 $)0 mg- S2 ca!sulesA0 C0 $)0 $B0 );0 >00 mg-

inection)? ?0 mg as ? mgNmL

1"aluate !atient carefully to determine the a!!ro!riate dose of this drug.

+ngina A0 mg > times daily 'elderlyinitially twice daily(- increased if

necessary to >A0 mg daily

Pediatric& Safety and efficacy not established.

Con8$H&n#&(H8&on!e(H8&on!

+llergy to diltia9em

im!aired he!atic or renal function

sick sinus syndrome hy!otension

!ulmonary congestion and 4I

heart block 'second or third degree( and

lactation

V" "II"(8!

,/S&6i99iness lightheadedness headache asthenia fatigue %I&/ausea he!atic inury

,


53/168

2e!ort irregular heart beat shortness of breath swelling of the hands or feet !ronounced

di99iness consti!ation.

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

O

Y[. AoP8Hm&n" 7y#$o(7lo$",

U$H#" nHm"& 6obutre3

A$% (lH!!"!,

Sym!athomimetic

$selecti"e adrenergic agonist


U7"$HK"8&( H(8&on!,

Positi"e inotro!ic effects are mediated by $ adrenergic rece!tors in the heart- increases the force

of myocardial contraction with relati"ely minor effects on heart rate arrhythmogenesis- has minor

effects on blood "essels.

*n#&(H8&on!

8or inotro!ic su!!ort in the shortterm treatment of adults with cardiac decom!ensation

due to de!ressed contractility resulting from either organic heart disease or from

cardiac surgical !rocedures

In"estigational use in children with congenital heart disease undergoing diagnostic

cardiac catheteri9ation to augment ,< function

Ao!H%"

+"ailable 8orms& Inection $).? mgNmL.

+dminister only by I< infusion.

*itrate on the basis of the !atientEs homodynamicNrenal res!onse.

,lose monitoring is necessary.

L#l8,

).?$? \gNkgNmin I< is usual rate to increase cardiac out!ut- rarely rates u! to ;0 \gNkg

!er minute are needed.

*f IH(8!

G$"KH$H8&on,2econstitute by adding $0 mL Sterile ater for Inection or ?Q 6e3trose

Inection to )?0mg "ial. If material is not com!letely dissol"ed add $0 mL of diluent.

?)


54/168

8urther dilute to at least ?0 mL with ?Q 6e3trose Inection 0.CQ Sodium ,hloride

Inection or Sodium Lactate Inection. Store reconstituted solution under refrigeration for

;B h or at room tem!erature for A h. Store final diluted solution in glass or "ia fle3 container

at room tem!erature. Stable for ); h. 6o not free9e. '/ote& drug solutions may e3hibit a

color that increases with time- this indicates o3idation of the drug not a loss of !otency.( *nI!&on,4ay be administered through common I< tubing with do!amine lidocaine

tobramycin nitro!russide !otassium chloride or !rotamine sulfate. *itrate rate based on

!atient res!onseP 5P rhythm- use of an infusion !um! is suggested.

*n(omKH8&P&l&8&"!,6onotmi3 drug with alkaline solutions such as ?Q Sodium

5icarbonate Inection- do notmi3 with hydrocortisone sodium succinate cefa9olin

cefamandole neutral ce!halothin !enicillin sodium ethacrynate- sodium he!arin.

gJ!&8" *n(omKH8&P&l&8&"!,6o not mi3 with acyclo"ir alte!lase amino!hylline foscarnet.

L#Q"$!" "II"(8!

,/S&7eadache

%I&/ausea

,


55/168


56/168

Suggested dilution&

*ransfer contents of one am!oule '?ml containing )00 mg of do!amine( by ase!tic

techniue to either )?0 or ?00 ml bottle of sterile I.


57/168

6o3ychel 7yclate 6o3ytec /o"o6o3ylin /u

6o3ycycline


58/168

Uncom!licated genital ,hlamydia nongonococcal urethritis $00 mg twice daily

for D days '$; days in !el"ic inflammatory disease

+nthra3'treatment or !oste3!osure !ro!hyla3is $00 mg twice daily-

,hild'only if alternati"e antibacterial cannot be gi"en( Wunlicensed doseX ? mgNkg

daily in ) di"ided doses 'ma3. )00 mg daily(

%eriatric or 2enal 8ailure Patients&

I< doses of do3ycycline are not as to3ic as other tetracyclines in these !atients.

L#Q"$!" "II"(8!

%I&8atty li"er li"er failure anore3ia nausea "omiting diarrhea glossitis dys!hagia

enterocolitis eso!hageal ulcer

7ematologic&7emolytic anemia thrombocyto!enia neutro!enia eosino!hilia

leukocytosis leuko!enia

6ermatologic&Phototo3ic reactions rash e3foliati"e dermatitis 'more freuent and more

se"ere with this tetracycline than with any others(

6ental&6iscoloring and inadeuate calcification of !rimary teeth of fetus if used by

!regnant women discoloring and inadeuate calcification of !ermanent teeth if used during

!eriod of dental de"elo!ment

Local&Local irritation at inection site

Other&Su!er infections ne!hrogenic diabetes insi!idus syndrome

Cl&n&(Hlly &mKo$8Hn8 &n8"$H(8&on!

6rugdrug

6ecreased absor!tion with antacids iron alkali

6ecreased thera!eutic effects with barbiturates carbama9e!ine !henytoins

Increased digo3in to3icity with do3ycycline

Increased ne!hroto3icity with metho3yflurane

6ecreased acti"ity of !enicillins

6rugfood

6ecreased effecti"eness of do3ycycline if taken with food dairy !roducts

6ruglab test

?D


59/168

Interference with culture studies for se"eral days following thera!y

@$!&n% (on!"$H8&on,

+dminister the oral medication without regard to food or meals- if %I u!set occurs

gi"e with meals. 6o not gi"e with antacid milk or any !roduct that contains ,alcium Gink

aluminum magnesium and ferrous salts because these !roducts decrease the

absor!tion of the drug.

Protect !atient from light and sun e3!osure.

2e!ort rash itching- difficulty breathing- dark urine or lightcolored stools- !ain at

inection site

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

YF. 'nHlHK$&l T ConQ"$8&n W ,

U$H#" nHm"!& 1nala!rilat ,on"ertin

A$% (lH!!"!

+ntihy!ertensi"e +,1 inhibitor

G$"%nHn(y,',ategory ,N 6 if used in the )nd or >rd trimesters.X

U7"$HK"8&( H(8&on!

2enin synthesi9ed by the kidneys is released into the circulation where it acts on a

!lasma !recursor to !roduce angiotensin I which is con"erted by angiotensin

con"erting en9yme to angiotensin II a !otent "asoconstrictor that also causes

release of aldosterone from the adrenals- both of these actions increase 5P. 1nala!ril

blocks the con"ersion of angiotensin I to angiotensin II decreasing 5P decreasing

aldosterone secretion slightly increasing serum le"els and causing /aand fluid

loss- increased !rostaglandin synthesis also may be in"ol"ed in the antihy!ertensi"e

action.

*n#&(H8&on!

*reatment of hy!ertension alone or in combination with thia9idety!e diuretics

*reatment of acute and chronic ,78

?B


60/168

*reatment of asym!tomatic left "entricular dysfunction 'L


61/168

release during surgery will be blocked- hy!otension may be re"ersed with "olume

e3!ansion.

4onitor !atients on diuretic thera!y for e3cessi"e hy!otension following the first few doses

of enala!ril.

4onitor !atient closely in any situation that may lead to a fall in 5P secondary to reduced

fluid "olume 'e3cessi"e !ers!iration and dehydration "omiting diarrhea( because

e3cessi"e hy!otension may occur.

+rrange for reduced dosage in !atients with im!aired renal function.

4onitor !atient carefully because !eak effect may not be seen for ; h. 6o not administer

second dose until checking 5P.

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

Y`. 'noXHKH$&n TCl"XHn" W ,

U$H#" nHm",Lo"eno3

A$% (lH!!"!

Lowmolecularweight he!arin

+ntithrombotic agent


U7"$HK"8&( H(8&on!

Low molecular weight he!arin that inhibits thrombus and clot formation by blocking factor

Va factor IIa !re"enting the formation of clots.

*n#&(H8&on!

Pre"ention of dee! "ein thrombosis which may lead to !ulmonary embolism

following hi! re!lacement knee re!lacement surgery abdominal surgery

Pre"ention of ischemic com!lications of unstable angina and nonHwa"e 4I

*reatment of dee! "ein thrombosis '6


62/168

Ao!"

Pro!hyla3is of dee!"ein thrombosisin medical !atients by subcutaneous inection ;0 mg

';000 units( e"ery ); hours for at least A days until !atient ambulant 'ma3. $; days(

*reatment of dee!"ein thrombosis or !ulmonary embolismby subcutaneous inection

$.? mgNkg '$?0 unitsNkg( e"ery ); hours usually for at least ? days 'and until adeuate oralanticoagulation established(

Unstable angina and nonS*segmentele"ation myocardial infarction by subcutaneous

inection $ mgNkg '$00 unitsNkg( e"ery $) hours usually for )MB days 'minimum ) days(

L#Q"$!" "II"(8!

7ematologic&7emorrhage- bruising- thrombocyto!enia- ele"ated +S* +L* le"els-

hy!erkalemia

7y!ersensiti"ity& ,hills fe"er urticaria asthma Other& 8e"er- !ain- local irritation hematoma erythema at site of inection


6rugdrug

Increased bleeding tendencies with oral anticoagulants salicylates !enicillins

ce!halos!orins

6ruglab test

Increased +S* +L* le"els

6rugalternati"e thera!y

Increased risk of bleeding if combined with chamomile garlic ginger gingko

and ginseng thera!y

@$!&n% Con!"$H8&on!

%i"e drug as soon as !ossible after hi! surgery.

%i"e dee! S, inections- do not gi"eeno3a!arin by I4 inection.

+dminister by dee! S, inection- !atient should be lying down. +lternate between the left

and right anterolateral and !osterolateral abdominal wall. Introduce the whole length of the

needle into a skin fold held between the thumb and forefinger- hold the skin fold throughout

the inection.

A$


63/168

+!!ly !ressure to all inection sites after needle is withdrawn- ins!ect inection sites for

signs of hematoma- do not massage inection sites.

6o not mi3 with other inections or infusions.

Store at room tem!erature- fluid should be clear colorless to !ale yellow.

Pro"ide for safety measures 'electric ra9or soft toothbrush( to !re"ent inury to !atient who

is at risk for bleeding.

,heck !atient for signs of bleeding- monitor blood tests.

+lert all health care !ro"iders that !atient is on eno3a!arin.

6iscontinue and initiate a!!ro!riate thera!y if thromboembolic e!isode occurs des!ite

eno3a!arin thera!y.

7a"e !rotamine sulfate 'eno3a!arin antidote( on standby in case of o"erdose.

*reat o"erdose as follows& Protamine sulfate '$Q solution(. 1ach mg of !rotamineneutrali9es $ mg eno3a!arin. %i"e "ery slowly I< o"er $0 min.

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

ZE. 'K7"#$&n" !lIH8"

U$H#" nHm",/asal decongestant& Pret96

A$% (lH!!"!

Sym!athomimetic drug


64/168

*n#&(H8&on!

*reatment of hy!otensi"e states es!ecially those associated with s!inal anesthesia- Stokes

+dams syndrome with com!lete heart block- ,/S stimulant in narcole!sy and de!ressi"e

states- acute bronchos!asm '!arenteral(

Pressor agent in hy!otensi"e states following sym!athectomy o"er dosage with ganglionicblocking agents antiadrenergic agents or other drugs used for lowering 5P '!arenteral(

2elief of acute bronchos!asm '!arenteral- e!ine!hrine is the !referred drug(

*reatment of allergic disorders such as bronchial asthma and local treatment of nasal

congestion in acute cory9a "asomotor rhinitis acute sinusitis hay fe"er 'oral(

Sym!tomatic relief of nasal and naso!haryngeal mucosal congestion due to the common

cold hay fe"er or other res!iratory allergies 'to!ical(

+duncti"e thera!y of middle ear infections by decreasing congestion around the eustachian

ostia 'to!ical(


,ontraindications& allergy to e!hedrine angleclosure glaucoma anesthesia with

cyclo!ro!ane or halothane thyroto3icosis diabetes hy!ertension ,< disorders women in

labor whose 5P [ $>0NB0.

Use cautiously with angina arrhythmias !rostatic hy!ertro!hy unstable "asomotor

syndrome lactation.

Ao!H%"

L#l8

Hypotensive episodes, allergic disorders, asthma:

)??0 mg I4 'fast absor!tion( S, 'slower absor!tion( or I< 'emergency administration(.

Labor:

*itrate !arenteral doses to maintain 5P at or below $>0NB0.

Acute asthma:

+dminister the smallest effecti"e dose '0.)?0.? mL or $).?)? mg(.

Maintenance dosage--allergic disorders, asthma:

)??0 mg PO >;h as necessary.

Topical nasal decongestant:

A>


65/168

Instill solution in each nostril ;h. 6o not use longer than >; consecuti"e days.

G"#&H8$&(,

)?$00 mgNm)I4 or S, di"ided into ; to A doses- > mgNkg !er day or $00 mgNm)!er day di"ided

into ; to A doses PO S, or I< for bronchodilation.

Topical nasal decongestant (> 6 y:

Instill solution in each nostril ;h. 6o not use for longer than >; consecuti"e d. 6o not use in

children [A y unless directed by !hysician.

h"$&H8$&(,

4ore likely to e3!erience ad"erse reactions- use with caution.

L#Q"$!" "II"(8!

Systemic effects are less likely with to!ical administration but can take !lace and should be

considered.

,/S&$ear, anxiety, tenseness, restlessness, headache, light"headedness, di##iness

drowsiness tremor insomnia hallucinations !sychological disturbances con"ulsions ,/S

de!ression weakness blurred "ision ocular irritation tearing !hoto!hobia sym!toms of

!aranoid schi9o!hrenia

%I&%ausea "omiting anore3ia

,


66/168

o 6ecreased hy!otensi"e action of guanethidine with e!hedrine

@$!&n% Con!"$H8&on!

Protect solution from light- gi"e only if clear- discard any unused !ortion.

4onitor urine out!ut with !arenteral administration- initially renal blood "essels may beconstricted and urine formation decreased.

6o not use nasal decongestant for longer than >? d.

+"oid !rolonged use of systemic e!hedrine 'a syndrome resembling an an3iety effect may

occur(- tem!orary cessation of the drug usually re"erses this syndrome.

4onitor ,< effects carefully- !atients with hy!ertension may e3!erience changes in 5P

because of the additional "asoconstriction. If a nasal decongestant is needed gi"e

!seudoe!hedrine.ZS. '$y87$omy(&n ,

U$H#" nHm"!,1ramycin 1rythrocin

A$% (lH!!, 4acrolide antibiotic


U7"$HK"8&( H(8&on!

Inhibits !rotein synthesis of microorganisms by binding to ribosome.

It is effecti"e only against ra!idly multi!lying organisms.

+bsorbed readily from the u!!er %I* 'small intestine(.

+re manufactured in enteric Mcoated or filmcoated forms to !re"ent destruction

by gastric acid diffuse !oorly to ,.S.8. J !rimarily e3creted in bile.

*n#&(H8&on!

!ystemic Administration

+cute infections caused by sensiti"e strains of &treptococcus pneumoniae, 'ycoplasma

pneumoniae, Listeria monocytogenes, Legionella pneumophila

U2Is L2Is skin and softtissue infections caused by grou! + hemolytic stre!tococci

when oral treatment is !referred to inectable ben9athine !enicillin

PI6 caused by%( gonorrhoeaein !atients allergic to !enicillin

In conunction with sulfonamides in U2Is caused byHaemophilus influen#ae

+s an adunct to antito3in in infections caused by )orynebacterium diphtheriaeand

)orynebacterium minutissimum

A?


67/168

Pro!hyla3is against ^hemolytic stre!tococcal endocarditis before dental or other

!rocedures in !atients allergic to !enicillin who ha"e "al"ular heart disease

"ral #rythromycin

*reatment of intestinal amebiasis caused byEntamoeba histolytica- infections in thenewborn and in !regnancy that are caused by )hlamydia trachomatisand in adult

chlamydial infections when tetracycline cannot be used- !rimary sy!hilis '*reponema

pallidum( in !enicillinallergic !atients- eliminating+ordetella pertussisorganisms from

the naso!haryn3 of infected indi"iduals and as !ro!hyla3is in e3!osed and susce!tible

indi"iduals.

Unlabeled uses& erythromycin base is used with neomycin before colorectal surgery to

reduce wound infection- treatment of se"ere diarrhea associated with )ampylobacter

enteritis or enterocolitis- treatment of genital inguinal or anorectal lym!hogranuloma

"enereum infection- treatment ofHaemophilus ducreyi'chancroid(

"phthalmic "intment

*reatment of su!erficial ocular infections caused by susce!tible strains of microorganisms-

!ro!hyla3is of o!hthalmia neonatorum caused by%( gonorrhoeae or )( trachomatis

Topical $ermatologic !olutions %or Acne

*reatment of acne "ulgaris

Topical $ermatologic "intment

Pro!hyla3is against infection in minor skin abrasions

*reatment of skin infections caused by sensiti"e microorganisms



,ontraindication& allergy to erythromycin.

Use cautiously with he!atic dysfunction lactation 'secreted and may be concentrated in

breast milk- may modify bowel flora of nursing infant and interfere with fe"er worku!s(.

"phthalmic "intment

,ontraindications& allergy to erythromycin- "iral fungal mycobacterial infections of the

eye.

AA


68/168

Ao!H%"

+"ailable 8orms& 5ase& *ablets)?0 >>> ?00 mg- 62 ca!sules)?0 mg- o!hthalmic ointment?

mgNg. 1stolate& *ablets?00 mg- ca!sules)?0 mg- sus!ension$)? )?0 mgN? mL. Stearate&

*ablets)00 ;00 mg- sus!ension)00 ;00 mgN? mL $00 mgN)? mL- !owder for sus!ension

)00 mgN? mL- granules for sus!ension;00 mgN? mL- to!ical solution$.?Q )Q- to!ical gelointment)Q.

Systemic administration&

Oral !re!arations of the different erythromycin salts differ in !harmacokinetics& ;00 mg

erythromycin ethylsuccinate !roduces the same free erythromycin serum le"els as )?0 mg of

erythromycin base sterate or estolate.

Adult:

$?)0 mgNkg !er day in continuous I< infusion or u! to ; gNd in di"ided doses Ah- )?0 mg ';00

mg of ethylsuccinate( Ah PO or ?00 mg $)h PO or >>> mg Bh PO u! to ; gNd de!ending on

the se"erity of the infection.

Stre!tococcal infections&

)0?0 mgNkg !er day PO in di"ided doses 'for grou! + hemolytic stre!tococcal infections

continue thera!y for at least $0 d(.

LegionnaireEs disease&

$; gNd PO or I< in di"ided doses 'ethylsuccinate $.A gNd- o!timal doses not established(.

6ysenteric amebiasis&

)?0 mg ';00 mg of ethylsuccinate( PO id or >>> mg Bh for $0$; d.

+cute !el"ic inflammatory disease '/. gonorrhoeae(&

?00 mg of lactobionate or gluce!tate I< Ah for > d and then )?0 mg stearate or base PO Ah or

>>> mg Bh for D d.

Pertussis&

;0?0 mgNkg !er day PO in di"ided doses for ?$; d 'o!timal dosage not established(.

Pro!hyla3is against bacterial endocarditis before dental or u!!er res!iratory !rocedures& $ g '$.A g

of ethylsuccinate( A h later.

,hlamydial infections&

AD


69/168

Urogenital infections during !regnancy& ?00 mg PO id or AAA mg Bh for at least D d $N) this

dose Bh for at least $; d if intolerant to first regimen. Urethritis in males& B00 mg of

ethylsuccinate PO tid for D d.

Primary sy!hilis&

>0;0 g ';BA; g of ethylsuccinate( in di"ided doses o"er $0$? d.

,6, recommendations for S*6s&

?00 mg PO id for D>0 d de!ending on the infection.

&ediatric:

>0?0 mgNkg !er day PO in di"ided doses. S!ecific dosage determined by se"erity of infection

age and weight.

6ysenteric amebiasis&

>0?0 mgNkg !er day in di"ided doses for $0$; d.

Pro!hyla3is against bacterial endocarditis&

)0 mgNkg before !rocedure and then $0 mgNkg A h later.

,hlamydial infections&?0 mgNkg !er day PO in di"ided doses for at least ) 'conuncti"itis of newborn( or > '!neumonia

of infancy( wk.

O!hthalmic ointment&

$N)in ribbon instilled into conuncti"al sac of affected eye two to si3 times !er day de!ending on

se"erity of infection.

*o!ical dermatologic solution for acne&

+!!ly to affected areas morning and e"ening.

*o!ical dermatologic ointment&

+!!ly to affected area $? _Nd.

L#Q"$!" "II"(8!

Systemic +dministration

,/S&2e"ersible hearing loss confusion uncontrollable emotions abnormal thinking

AB


70/168

%I&+bdominal cram!ing anore3ia diarrhea "omiting !seudomembranous colitis

he!atoto3icity

7y!ersensiti"ity&+llergic reactions ranging from rash to ana!hyla3is

Other&Su!er infections

O!hthalmic Ointment

6ermatologic& 1dema utricaria dermatitis angioneurotic edema

Local& Irritation burning itching at site of a!!lication

*o!ical 6ermatologic Pre!arations

Local&Su!er infections !articularly with longterm use



6rugdrug

Increased serum le"els of digo3in

Increased effects of oral anticoagulants theo!hyllines carbama9e!ine

Increased thera!eutic and to3ic effects of corticosteroids

Increased le"els of cyclos!orine and risk of renal to3icity

*o!ical 6ermatologic Solution for +cne

6rugdrug

Increased irritant effects with !eeling desuamating or abrasi"e agents


6ruglab test

Interferes with fluorometric determination of urinary catecholamines

6ecreased urinary estriol le"els due to inhibition of hydrolysis of steroids in the

gut

@$!&n% Con!"$H8&on,

AC


71/168


,ulture site of infection before thera!y.

+dminister oral erythromycin base or stearate on an em!ty stomach $ h before or )> h

after meals with a full glass of water 'oral erythromycin estolate ethylsuccinate and

certain entericcoated tablets Wsee manufacturerEs instructionsX may be gi"en without regard

to meals(.

+dminister around the clock to ma3imi9e effect- adust schedule to minimi9e slee!

disru!tion.

4onitor li"er function in !atients on !rolonged thera!y.

%i"e some !re!arations 'see abo"e( with meals or substitute one of these !re!arations if

%I u!set occurs with oral thera!y.

Topical $ermatologic !olution %or Acne

ash affected area rinse well and dry before a!!lication.

"phthalmic and Topical $ermatologic &reparation

Use to!ical !roducts only when needed. Sensiti9ation !roduced by the to!ical use of an

antibiotic may !reclude its later systemic use in serious infections. *o!ical antibiotic

!re!arations not normally used systemically are best.

,ulture site before beginning thera!y.

,o"er the affected area with a sterile bandage if needed 'to!ical(.

ZD. '!om"K$Hbol",

U$H#" nHm"!,/e3ium

ClH!!,Proton !um! inhibitors antinuclear agents


L(8&on,

5inds to an en9yme on gastric !arietal cells in the !resence of acidic gastric !7 !re"enting

the final trans!ort of hydrogen ions into the gastric lumen.

U7"$HK"8&( 'II"(8!,

o 6iminished accumulation of acid in the gastric lumen with lessened

gastroeso!hageal reflu3

o 7ealing of duodenal ulcers.

D0


72/168

+!"!,

*reatment of %126 including&

o 7ealing of erosi"e eso!hagitis

o 4aintenance of healing of erosi"e eso!hagitis

o *reatment of sym!tomatic %126

In combination with amo3icillin and clarithromycin for the eradication of 7elicobacter

!ylori in !atients with duodenal ulcer disease or a history of duodenal ulcer disease.

'Information on cucurrent use with amo3icillin and clarithromycin can be found in 6a"isEs

6rug %uide for /urses.

Ao!",

%astrooeso!hageal reflu3 disease ;0 mg once daily for ; weeks followed by a further ;

weeks if not fully healed or sym!toms !ersist- maintenance )0 mg daily-

sym!tomatic treatment in the absence of oeso!hagitis )0 mg daily for u! to ;

weeks followed by )0 mg daily when reuired

,7IL6 & not recommended

Con8$H&n#&(H8&on!,

7y!ersensiti"ity

Lactation 'not recommended(.

V" "II"(8!,

,/S& headache.

%I& abdominal !ain consti!ation diarrhea dry mouth flatulence nausea.

@$!&n% (on!"$H8&on!,

/1VIU4 should be taken at least one hour before meals.

8or !atients who ha"e a nasogastricor gastric tube in !lace /1VIU4 8or 6elayed2elease

Oral Sus!ension can be administered as follows&

+dd $? mL of water to a catheterti!!ed syringe and then add the contents of a $0 mg

)0 mg or ;0 mg /1VIU4 !acket. It is im!ortant to only use a catheter ti!!ed syringe

when administering /1VIU4 through a nasogastric tubeor gastric tube.

Immediately shake the syringe and lea"e ) to > minutes to thicken.

Shake the syringe and inect through the nasogastric or gastric tube 8rench si9e A or

larger into the stomach within >0 minutes. 2efill the syringe with $? mL of water.

D$
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73/168

Shake and flush any remaining contents from the nasogastric or gastric tube into the

stomach.

/1VIU4 8or 6elayed2elease Oral Sus!ension should be administered as follows&

1m!ty the contents of a $0 mg )0 mg or ;0 mg !acket into a container containing $

tables!oon '$? mL( of water.

Stir.

Lea"e ) to > minutes to thicken.

Stir and drink within >0 minutes.

If any material remains after drinking add more water stir and drink immediately.

@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@

ZY. i"n8Hnyl,

U$H#" nHm"!,+cti 6uragesic 8entanyl Oralet 8entanyl

*ransdermal 8entanyl *ransmucosal Sublima9e

A$% (lH!!

/arcotic agonist analgesic

G$"%nHn(y,',ategory ,N 6 if used for !rolonged !eriods or in high doses at term(

U7"$HK"8&( H(8&on!

+cts at s!ecific o!ioid rece!tors causing analgesia res!iratory de!ression !hysical

de!ression eu!horia.

*n#&(H8&on!

+nalgesic action of short duration during anesthesia and immediate !osto! !eriod

+nalgesic su!!lement in general or regional anesthesia

+dministration with a neurole!tic as an anesthetic !remeditation for induction of

anesthesia and as an adunct in maintenance of general and regional anesthesia

8or use as an anesthetic agent with o3ygen in selected highrisk !atients

*ransdermal system& management of chronic !ain in !atients reuiring o!ioid analgesia

*reatment of breakthrough !ain in cancer !atients being treated with narcotics


,ontraindications&hy!ersensiti"ity to narcotics diarrhea caused by !oisoning acute

bronchial asthma u!!er airway obstruction !regnancy.

Use cautiouslywith bradycardia history of sei9ures lactation.

D)


74/168

Ao!"

by intravenous injection with s!ontaneous res!iration ?0M)00 micrograms then ?0 micrograms as

reuired- ,7IL6>M? microgramsNkg then $ microgramNkg as reuired

ith assisted "entilation 0.>M>.? mg then $00M)00 micrograms as reuired-

,hild&$? microgramsNkg then $M> microgramsNkg as reuired+y intravenous infusionn )-. /(0 1 2 microgramsNkg3 hour

L#Q"$!" "II"(8!

,/S&Sedation clamminess sweating headache "ertigo floating feeling di99iness

lethargy confusion lightheadedness ner"ousness unusual dreams agitation eu!horia

hallucinations delirium insomnia an3iety fear disorientation im!aired mental and

!hysical !erformance coma mood changes weakness headache tremor con"ulsions

%I&/ausea "omiting dry mouth anore3ia consti!ation biliary tract s!asm

,


75/168

@$!&n% Con!"$H8&on!

+dminister to women who are nursing a baby ;A h before the ne3t scheduled

feeding to minimi9e the amount in milk.

Pro"ide narcotic antagonist facilities for assisted or controlled res!iration on

standby during !arenteral administration.

Pre!are site by cli!!ing 'not sha"ing( hair at site- do not use soa! oils lotions

alcohol- allow skin to dry com!letely before a!!lication. +!!ly immediately

after remo"al from the sealed !ackage- firmly !ress the transdermal system in

!lace with the !alm of the hand for $0)0 sec making sure the contact is

com!lete. 4ust be worn continually for D) h.

Use caution with +cti form to kee! this drug out of the reach of children 'looks

like a lolli!o!( and follow the distribution restrictions in !lace with this drug

"ery carefully.

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