Classification Anti-Infective Agents

Penicillin penicillin V (Betapen) amoxicillin (Amoxil) ampicillin (Omnipen) cloxacillin (Tegopen) PO/IV/IM

Mechanism of Action

Indications

Contraindications Adverse Effects Nursing Considerations

Inhibition of cell wall synthesis

Mitral Valve Stenosis Endocarditis Sinusitis Pneumonia Gram-negative bacteria

Allergy Oral contraceptives (decreases OC efficacy) Kidney failure

Rash Pruritis N/V/D Allergic reaction** **Cephalosporins should also be used with caution**

Assess for history of allergy Post administration: clients can have an allergic reaction within 0- 30 minutes Pen. V and amoxicillin should be taken with food. All other penicillins should be taken medication with water, 1 hour before or 2 hours after meals Avoid taking with acidic fruit juices Clients must complete full course of treatment Use with caution in neonates r/t immature kidney function slowing elimination Hypernatremia and hyperkalemia are possible, but uncommon

Sulfonamide sulfamethoxazoletrimethoprim (Septra) sulfisoxazole (Generic) PO/IV/IM

Do not directly destroy bacteria; however they interfere with their growth by preventing the synthesis of folic acid (required to make the nucleus of DNA)

Sinusitis Pyelonephritis Meningitis Urinary Tract Infection Otitis Media Gram-negative bacteria Gram-positive bacteria Sinusitis Pyelonephritis Meningitis Urinary Tract Infection Skin Infections Gram-negative

Allergy Children under the age of 2 months Renal failure

Rash Photosensitivity N/V/D Allergic reaction

Assess for history of allergy Post administration: clients can have an allergic reaction within 0- 30 minutes Clients must complete full course of treatment Encourage fluids to produce a urine output of 1,200-1,500mL/day to avoid crystalluria (drug crystals in the urine

Cephalosporin cephalexin (Keflex) cefprozil (Cefzil) cefazolin (Cefazolin) ceftriaxone (Rocephin) PO/IV/IM

Inhibition of cell wall synthesis

Allergy Alcohol Oral contraceptives (decreases OC efficacy)

Rash Pruritis N/V/D Allergic reaction

Assess for history of allergy Post administration: clients can have an allergic reaction within 0- 30 minutes Clients must complete full course of treatment Used cautiously because immature

bacteria Gram-positive bacteria

kidney function slows elimination Dosages must be reduced by the prescriber in the presence of renal impairment Allergy Pregnancy Not to be given to children under the age of 8 (r/t permanent discoloration of teeth) Oral contraceptives (decreases OC efficacy) Allergy Warfarin use (increases serum concentration) Liver disease N/V/D Overgrowth of nonsusceptible organisms (i.e. Candidiasis) Discoloration of teeth Photosensitivity Avoid taking with antacids, dairy products, iron preparations, or antidiarrheal medications ( levels) Avoid exposure to sunlight Clients must complete full course of treatment

Tetracyclines doxycycline (Vibramycin) minocycline (Minocin) tetracycline (Achromycin) PO/IV

Inhibition of bacterial protein synthesis

Pyelonephritis Meningitis Urinary Tract Infection Otitis Media Pneumonia Gram-negative bacteria Gram-positive bacteria

Macrolide azithromycin (Zithromax) clarithromycin (Biaxin) erythromycin (Generic) PO Fluoroquinolones ciprofloxacin (Cipro) levofloxacin (Levaquin) moxifloxacin (Avelox) PO/IV

Inhibition of bacterial protein synthesis

Pyelonephritis Urinary Tract Infection Pneumonia Gram-positive bacteria

N/V/D Rash Palpitations

Clients must complete full course of treatment Avoid taking with fruit juices

Inhibition of bacterial enzymesstops DNA synthesis in the cell

Pyelonephritis Urinary Tract Infection Pneumonia Gram-negative bacteria Gram-positive bacteria

Liver disease Kidney disease Warfarin use (increases serum concentration) Not to be used in children under the age of 18 (safety has not been established) Allergy Kidney disease Pregnancy (can cause congenital bilateral deafness in

N/V/D Candidiasis Photosensitivity Tendon injury (tendonitis r/t apoptosis and decreased collagen synthesis in a tendon

Clients must complete full course of treatment Encourage fluids to produce a urine output of 1,200-1,500mL/day to avoid crystalluria (drug crystals in the urine) Avoid exposure to sunlight

Aminoglycoside gentamicin sulfate (Gentamicin) tobramicin sulfate (Tobramycin)

Inhibit cell wall synthesis

VRE Skin infections (folliculitis) Gram-negative bacteria

Nephrotoxicity Ototoxicity Skin rash Headache Dizziness

Monitor blood levels of the medication Assess for toxicity (i.e. hearing loss/tinnitus, kidney failure) Preferred choice for VRE infections

IV

children if taken during pregnancy) Inhibits DNA synthesis of a cell C. Diff Bacterial Vaginosis Trichomonas Alcohol use Liver disease Dizziness GI upset Headache Neurotoxicity (seizures) N/V Dizziness Headache Encourage client to take with food/milk Alcohol should not be consumed during, and for at least 24 hours after last dose Clients must complete full course of treatment Increase fluids to 1,200-1,500 mL/day

Nitroimidazole metronidazole (Flagyl) PO/IV

Nitrofuran nitrofurnantoin (MacroBID) PO

Interferes with the activity of enzymes that regulate bacteria metabolism and disrupts cell wall synthesis Binds to the cell wall and produces inhibition of cell wall synthesis

Urinary Tract Infection

Allergy Kidney disease

Glycopeptide vancomycin (Vancocin) IV/PO

MRSA C. Diff

Kidney disease Hearing loss

Ototoxicity Kidney failure Skin rash Hypotension Flushing of the skin

Monitor blood levels of the medication Assess for toxicity (i.e. hearing loss, kidney failure) Preferred choice for MRSA infections

Laxatives
Stimulant bisacodyl (Dulcolax) senna (Senokot) sennosides (Ex-Lax; USA) PO/PR Irritates intestinal smooth muscle + colonic intramural plexus increased peristalsis Promotes some water into stool Constipation Bulk Forming psyllium (Metamucil) methylcellulose (Entrocel, Citrucel) PO Increase size and softness of stool triggering peristalsis Absorbs water into stool Constipation IBS **Has shown to lower LDL in Hypercholesteremia Allergy Acute abdomen Intestinal obstruction Undiagnosed abdo pain Appendicitis Electrolyte imbalance Renal failure Children < 6 years Diarrhea Abdo cramping Electrolyte imbalances Dizziness Assess fluid and electrolytes Increase dietary fibre (whole grain, bran, fruit, greens) Increase water intake Long-term use (7d+) results in low bowel tone = dependency May interact with milk/juices/antacids

same

Constipation Abdo cramping Flatulence

Assess fluid and electrolytes Increase dietary fibre (whole grain, bran, fruit, greens) Increase water intake Long-term use (7d+) results in low

bowel tone = dependency May interact with milk/juices/antacids Usually taken hs; onset = 6-8 hrs (mineral oil) or 24-72 hr (docusate sodium) Assess fluid and electrolytes Increase dietary fibre (whole grain, bran, fruit, greens) Increase water intake Long-term use (7d+) results in low bowel tone = dependency Safe in pregnancy docusate should not be taken within 2 hrs of mineral oil r/t mineral oil absorbed by the body May interact with milk/juices/antacids 30 min 3 hr onset Assess fluid and electrolytes Increase dietary fibre(whole grain, bran, fruit, greens) Increase water intake Long-term use (7d+) results in low bowel tone = dependency Safe in pregnancy May interact with milk/juices/antacids

Emollient docusate sodium (Colace) mineral oil (Fleet* mineral oil enema) *sodium phosphate/Fleet is the more common saline enema* PO/PR

Lubricates intestinal wall Promotes water and fat into stool

Constipation Diagnostic preparations (i.e. colonoscopy)

Others are same Caution in pregnancy

Cramping Diarrhea

BP Diarrhea Abdo cramping Electrolyte imbalances Muscle cramping Dizziness

Saline Laxative magnesium sulfate (Epsom Salts) magnesium citrate (Citro-Mag) magnesium hydroxide (Milk of magnesia/MOM; Diovol) sodium phosphate (Fleet) PO (liquid or tablet) Hyperosmotic glycerin (Glycerin supp.) Lactulose (APOLactulose) sorbitol polyethylene glycol; PEG (Restoralax, PegLyte)

Increases osmotic retention of fluid Increases peristalsis

Constipation Diagnostic preparations (i.e. colonoscopy)

same Children < 2 years

Increases stool water content Promotes peristalsis **Lactulose can be used to decrease serum ammonia; seen in portal systemic encephalopathy**

Constipation Diagnostic preparations (i.e. colonoscopy)

same Diabetes (lactulose contains lactose)

BP Diarrhea Abdo cramping Electrolyte imbalances Belching & flatulence

Assess fluid and electrolytes Increase dietary fibre(whole grain, bran, fruit, greens) Increase water intake Long-term use (7d+) results in low bowel tone = dependency Safe in pregnancy May interact with milk/juices/antacids

PO

Diabetes
Insulin Rapid Acting NovoRapid Humalog Short Acting Humulin R Novolin ge Toronto Intermediate Acting Novolin ge NPH Long Acting Lantus IV/SC

Insulin is a hormone Acts on cells in pancreas Helps to metabolize proteins, fats and carbohydrates Helps to store glucose in the liver Moves glucose from blood to cells

Type 1 Diabetes Type 2 Diabetes

Allergy Hypoglycemia Corticosteroids (increases glucose) Diuretics (increases glucose) Birth control (increases glucose)

Hypoglycemia

Insulins differ in onset and duration of action Insulin can not be given orally; must be given subcutaneously or IV (regular insulin) Insulin can be stored at room temperature or in the fridge Injection sites can not be used more than once a month (must move at least inch from previous site) Effective management requires a consistent schedule of meals, snacks, exercise, injections and blood glucose monitoring Impaired vision may result in inaccurate dosages Should not be taken at bedtime Should be taken no more than 30 minutes prior to eating Meals and snacks should be taken routinely

Sulfonylureas glyburide (Diabeta) gliclazide (Diamicron) glimepiride (Amaryl) PO

Stimulate the pancreas to produce more insulin (therefore ineffective if cells of the pancreas can no longer function) Acts by decreasing the hepatic production of glucose (gluconeogenesis) Helps to decrease intestinal absorption of glucose Helps to improve insulin receptor sensitivity Does not increase insulin secretion, thus does not cause hypoglycemia

Type 2 Diabetes

same Alcohol (lowers glucose)

Hypoglycemia Weight gain Hemolytic anemia Nausea

Biguanides metformin (Glucophage) PO

Type 2 Diabetes

Allergy Hypoglycemia Some antacids Iodine containing contrast mediums

Diarrhea Nausea Metallic taste in mouth Anorexia

Must be taken with meals Must stop medication 48 hours prior to iodine radiological studies

Thiazolidinediones pioglitazone (Actos) rosiglitazone (Avandia) PO

Helps to enhance the sensitivity of insulin receptors Helps to stimulate glucose storage Inhibits glucose production in the liver

Type 2 Diabetes

Allergy Hypoglycemia

Edema Weight gain Liver failure

Can be taken with or without food

Meglitinides repaglinide (GlucoNorm) nateglinide (Starlix)

Stimulates the pancreas to produce more insulin (therefore ineffective if cells of the pancreas can no longer function)

Type 2 Diabetes

Antifungal medications (lowers glucose) Nonsteroidal antiinflammatory medications (NSAIDS) (lowers glucose) Anti-seizure medications (increases glucose)

Hypoglycem ia Headache Dizziness

Must be taken 0 to 30 minutes before meals If a meal is skipped, the dose should be skipped. If a meal added, then a dose should be added

Respiratory
Antitussive Non-opioid dextromethorphan (Benylin/Buckleys/Rob itussin) Opioid Hydrocodone/Codeine PO Suppress cough reflex by numbing stretch receptors in resp. tract cough reflex not initiated or Suppress the cough reflex; medulla Cough (nonproductive only!) URTI (viral and bacterial Allergy Opioid dependency Children <6 years of age Risk for respiratory depression Drowsiness/sedation Dizziness N/V Constipation (opioids) Adequate respiratory assessment Avoid driving, operating heavy machinery Push fluid intake

Decongestants Adrenergic Agonist pseudoephedrine (Sudafed) oxymetazoline (Vicks/Dristan/Dimeta pp) xylometazoline (Otrivin/Triaminic) Corticosteroid budesonide

Vasoconstriction of arterioles of nasal mucosa Anti-inflammatory effect

Allergies URTI (viral and bacterial) Rhinitis Sinusitis

Allergy HTN Diabetes Hyperthyroidism

Mucosal dryness/irritation Palpitations Insomnia Tremors

Potential for rebound congestion (rhinitis medicamentosa); if used >5 days nasal passage damage Avoid caffeine Report fever, productive cough, etc. lasting >5-7d

(Pulmicort/Symbicort) mometasone furoate (Nasonex) PO/INH Antihistamine (H1) diphenhydramine (Benadryl) cetirizine (Reactine) loratadine (Claritin) PO/IV/IM Compete with histamine for specific receptor sites **Remember: Histamine causes constriction of smooth muscles, increased body secretions, and vasodilatation** Dilates airways by stimulating 2-adrenergic receptors in lung tissue (bronchodilation) Rhinitis Anaphylaxis Allergies in general Glaucoma Pregnancy Heart disease Kidney disease Asthma Bronchitis COPD Allergy Cardiac dysrhythmia Hypertension (medications cause vasoconstriction) Under the age of 6 is limited Beta-blocker use (inhibits bronchodilation) Allergy Not recommended in children under the age of 12 Drowsiness (side effect) Anticholinergic effects Tachycardia Restlessness Dilated pupils Decreased salivation Urinary retention Tachycardia Insomnia Tremors Hyperglycemia May experience paradoxical excitement May cause confusion, dizziness, and hypotension diphenhydramine is sometimes used as a sleeping aid for occasional use Avoid driving and use of heavy machinery

Beta-adrenergic Agonist (2-Agonist) salbutamol (Ventolin) salmeterol (Serevent) terbutaline (Bricanyl) PO/INH

Preferred medication for acute respiratory symptoms Cardiac and respiratory assessments Hold breath for 5-10 seconds post inhalation Use a spacer or Aero chamber for administration Wait 2 minutes between inhalations Rinse mouth after inhalation (metallic taste) Do not use medication to terminate an acute attack Hold breath for 5-10 seconds post inhalation Use a spacer or Aero chamber for administration Wait 2 minutes between inhalations Rinse mouth after inhalation

Anticholinergic ipratropium bromide (Atrovent) INH

Block ACh (acetylcholine) receptors to prevent bronchoconstricti on **RememeberACh comes from the PSNS and causes bronchial constriction** Medications work in the same manner as naturally occurring steroid hormones

Asthma Bronchitis COPD

Anticholinergic effects Tachycardia Restlessness Dilated pupils Decreased salivation Urinary retention

Corticosteroids cortisone (Cortistan) hydrocortisone (Cortef)

Addisons Disease Asthma Inflammatory Bowel Disease

Allergy Cataracts Glaucoma Peptic ulcer disease

Impaired wound healing Masking of infections

(decrease absorption & increase excretion of calcium) Long-term use may cause Cushings disease/syndrome

methylprednisolone (Medrol) prednisone (Winpred) dexamethasone (Decadron) fluticasone (Flovent) PO/IV/IM/TOPICAL/I NH 1.

Xanthines theophylline (TheoDur) aminophylline (Somophylline) PO/IV

Gonadocorticoids: (androgens) contribute to onset of puberty Mineralocorticoids: recall function of aldosterone Glucocorticoids: (cortisol) Increase blood glucose by inhibiting insulin secretion and promoting gluconeogenesis 2. Breakdown lipids and proteins 3. Suppress the inflammatory response Influence CNS to affect mood Causes bronchodilation Acts on the CNS medulla to enhance respiratory drive

Rhinitis Pruritis Chronic Obstructive Pulmonary Disease Hodgkins Disease Leukemias Sinusitis

Psychiatric problems Systemic infections

Hypokalemia Peptic ulcers Edema Sodium/fluid retention Nausea Anxiety Weight gain Heart failure Increased intraocular pressure Fragile skin Candidiasis (inhaler use)

Oral glucocorticoids should be given in the morning to decrease amount of adrenal suppression Oral glucocorticoids should be given with milk or food to decrease GI upset Growth retardation is possible. Thus, smaller doses should be considered and accurate weekly height and weight must be documented Corticosteroids often aggravate other conditions (i.e. hypertension, CHF, diabetes, infection) Rinse mouth after inhaled use to prevent candidiasis

Asthma Bronchitis COPD

Allergy Cardiac dysrhythmia Seizure disorders Antibiotic use (increases serum levels of xanthine) Caffeine

N/V Anorexia Cardiac dysrhythmia

Limit caffeine intake Report s/s of toxicity (anorexia, N/V, hypotension, seizure) Limit cigarette smoking (reduces therapeutic effect of xanthines) Between 6 months and 16 years of age may need increased doses r/t rapid metabolization Under the age of 6 months have prolonged elimination r/t immature liver Very unpredictable r/t drug interactions, renal and hepatic impairment Monitor liver function tests (especially during early course of treatment) Do not use medication to terminate an acute attack

Antileukotrines montelukast sodium (Singulair) zafirlukast (Accolate) PO

Prevent smooth muscle contraction of the bronchi Decreases mucus secretion Decreases

Asthma

Allergy Allergy to lactose (inactive ingredient in antileukotrines) Liver disease

N/D Headache Liver failure

inflammation in lungs by preventing mobilization and migration of WBCs into the lungs

Cardiovascular
Anticoagulants Heparin dalteparin (Fragmin)(LMWH) enoxaprin (Lovenox)(LMWH) warfarin (Coumadin) PO/IV/IM/SC

Prevents thrombus formation Inhibits clotting factors in intrinsic pathway (Xa, IX, X, XI, XII & VIII) Inhibits prothrombin to thrombin & fibrinogen to fibrin

Venous Thrombosis Pulmonary Embolism Atrial Fibrillation CVA Thrombosis MI

Allergy Thrombocytopenia Active internal ( platelet count) Bleeding bleeding Severe hypertension HematuriaNausea Bleeding disorders Local irritation ASA/NSAIDS ( (preferably anticoagulant effect) injected SC into abdomen) Trauma Intracranial hemorrhage

Prophylaxis use only (they do not work on clots that have already formed) Monitor blood work, values such as aPTT (heparin use) and INR (warfarin use) Check for bleeding especially in gums and stool Heparin (20 min onset) usually starts therapy, followed by Warfarin (36h onset) Vitamin K is used to reverse effects of warfarin toxicity Protamine sulfate is used to reverse heparin effects Heparin containing benzyl alcohol must not be given to neonates (fatal reactions have been reported) When warfarin is used, all care providers should be informed to avoid unnecessary physical trauma More likely to experience bleeding complications dalteparin and enoxaparin can cause renal failure