Drug Name DOXYCYCLINE Brand name Vibramycin, Periostat Classification Pharmacologic class: Tetracycline Therapeutic class: Anti-infectives

Action May exert bacteriostatic effect by binding to the 30S and possibly 50S ribosomal units of microorganisms and inhibiting the protein synthesis. May also alter the cytoplasmic membrane of susceptible microorganisms.

Side Effects CNS: intracranial hypertension CV: pericarditis, thrombophlebitis, GI: diarrhea, epigastric distress, nausea, anorexia, glossitis, dysphagia, vomiting, oral candiasis, enterocolitis, anogenital inflammation HEMATOLOGIC: neutropenia, thrombocytopenia, eosinophilia, hemolytic anemia MUSCULOSKELETAL: bone growth retardation in children younger age 8. SKIN: maculopapular and erythematous rashes, photosensitivity, increased pigmentation and urticaria OTHER: anaphylaxis, hypersensitivity reactions, superinfections, permanent discolorations of teeth, enamel defects

1. 2.

Nursing Consideration Obtain specimen for culture and sensitivity. Check for expiration date because outdated tetracycline may cause reversible nephrotoxicity. 3. Monitor for signs and symptoms of superinfection in patients with long term and high dose use of this drug. 4. Check the patients tongue for fungal infection. Stress for oral hygiene. Patient teaching 1. Tell the patient to take entire amount of drug exactly as prescribed by the physician, even he feels better. 2. Photosensitivity may occur, warn patient to avoid direct sunlight and wear protective measures against light (i.e. sunscreens, sunglasses, protective clothing). 3. If in oral form, take it with food or milk if stomach upset happens. 4. Report occurrence of signs and symptoms of superinfection to physician promptly.

Drug Name GENTAMYCIN Brand name Garamycin Classification Pharmacologic class: Aminoglycoside

Action Inhibits protein synthesis by binding directly to the 30S ribosomal subunit; bactericidal.

Therapeutic class: Anti- infectives

Side Effects CNS: encephalopathy, seizures, fever, headache, lethargy, confusion, dizziness, numbness, peripheral neuropathy, vertigo, ataxia, tingling CV: hypotension EENT: ototoxicity, blurred vision, tinnitus GI: vomting, nausea GU: nephrotoxicity, possible in increase in the urinary excretion of casts HEMATOLOGIC: agranulocytosis, leucopenia, thrombocytopenia, anemia, eosinophilia MUSCULOSKELETAL: muscle twitching, myasthenia- gravis like symptoms RESPIRATORY: apnea SKIN: rash, urticaria, pruritus OTHER: anaphylaxis

Nursing Consideration 1. Obtain specimen for culture and sensitivity tests before giving, can be given awaiting results. 2. Evaluate hearing during and after therapy. 3. Weigh patient and review the renal function studies before therapy begins. 4. Monitor for renal function. 5. Watch for signs and symptoms of superinfections. 6. Therapy usually continues for 7-10 days. Patient teaching 1. Instruct patient to report promptly report adverse reactions. 2. Encourage the patient to drink plenty of fluids. 3. Warn patient to avoid hazardous activities if adverse CNS reactions occur.

Drug Name LACTULOSE Brand name Duphalac, Cephulac

Cholac,

Classification Pharmacologic class: Disaccharides

Action Produces an osmotic effect in the colon; it results in distention that promotes peristalsis. Also decreases ammonia, probably as a result of bacterial degradation, which lowers the pH of the colon contents.

Side Effects GI: abdominal cramps, belching, diarrhea, flatulence, gaseous distention, nausea, vomiting

Therapeutic class: Laxatives

Nursing Consideration 1. Dilute with water or fruit juice or give with food. 2. If as retention enema, dilute 200 g to 700 ml of water or normal saline solution for 30- 60 minutes. Use a rectal balloon 3. Monitor for hypernatremia, especially 8in high doses. 4. Monitor for mental status and potassium levels. 5. Replace fluid loss. Patient teaching 1. Show home care how to mix and use drug. 2. Inform the patient about the side effects and tell the patient to notify the physician reactions occur. 3. Instruct patient not to take laxatives during lactulose therapy.

Drug Name LEVOFLOXACIN Brand name Levaquin Classification Pharmacologic class: Fluoroquinolone Therapeutic class: Anti-infectives

Action Inhibits bacterial DNA gyrase and prevents DNA replication, transcription, repair, and recombination in susceptible bacteria.

Side Effects CNS: encephalopathy, seizures, dizziness, insomnia, pain, headache, paresthesia CV: chest pains, palpitations, vasodilation GI: pseudomembranous colitis, abdominal pain, constipation, pain, diarrhea, dyspepsia, flatulence, nausea, vomiting GU: vaginitis HEMATOLOGIC: lymphopenia, eosinophilia, hemolytic anemia METABOLIC: hypoglycemia MUSCULOSKELETAL: back pain, tendon rupture RESPIRATORY: allergic pneumonitis SKIN: erythema multiforme, Steven-Johnson syndrome, photosensitivity , pruritus, rash OTHER: anaphylaxis, multisystem organ failure, hypersensitivity reaction

Nursing Consideration 1. If patient experiences symptoms of excessive CNS stimulation, stop the drug and notify physician. Begin seizure precautions. 2. Patients with acute hypersensitivity reactions may need treatment with epinephrine, oxygen, IV fluids, antihistamines, corticosteroids and airway management. 3. Drug may cause abnormal ECG. 4. Obtain specimen for culture and sensitivity. 5. Monitor for glucose level and renal, hepatic and hematopoietic blood studies. 6. This can cause pseudomembranous colitis. If diarrhea occurs stop the drug and notify the physician.

Drug Name ISOSORBIDE MONONITRATE Brand name Monoket Classification Pharmacologic class: Nitrates Therapeutic class: Anti-anginals

Action Produces vasodilation. Increases coronary bloodflow by dilating coronary arteries and improving collateral flow to ischemic regions

Side Effects CNS: dizziness, headache CV: hypotension, tachycardia, bradycardia, syncope GI: nausea, vomiting OTHER: flushing, tolerance

paradoxic

Nursing Consideration 1. Monitor BP and PR 2. Tablets should be swallowed whole. 3. Take medications as prescribed. 4. Caution patient to slowly change positions to minimize orthostatic hypotension. 5. Avoid driving or other activities requiring alertness due to dizziness. 6. Avoid alcohol when taking medications. 7. Refer if with severe headache, dry mouth or blurred vision.

Drug Name ATENOLOL Brand name Tenormin Classification Pharmacologic class: Beta blockers Therapeutic class: Anti-anginals, anti hypertensives

Action Blocks stimulation of beta 1 (myocardial) adrenergic receptors. It decreases BP and HR and frequency of angina pectoris.

Side Effects CNS: fatigue, weakness EENT: blurred vision, stuffy nose RESP: bronchospasm, wheezing CV: bradycardia, pulmonary edema GI: constipation, nausea, vomiting GU: erectile dysfunction DERM: rashes ENDO: hyper or hypoglycemia MS: back pain

Nursing Consideration 1. Monitor BP, ECG and PR before, during and after therapy. 2. Monitor I and O and daily weights. 3. Instruct patient to take dose as prescribed. 4. Instruct patient to avoid activities requiring alertness. 5. Advise patient to notify physician if experiencing tachycardia, DOB, wheezing, confusion, double vision, dizziness or rash.

Drug Name ATAPULGITE Brand name Rheaban, Diasorb Classification Pharmacologic class: Therapeutic class: Anti diarrheal

Action It absorbs large numbers of bacteria and toxins reducing the loss of water. It reduces the number of bowel movements, improves

Side Effects Constipation, Rash, Itching, swelling, dizziness or DOB

Nursing Consideration 1. Check for allergies to the drug 2. Take medication as prescribed 3. Advise patient to notify physician if blood/mucus in the stool is detected or if fever occurs.

consistency of loose or watery stools and relieves the gastrointestinal cramping often associated with diarrhea.

DRUG Generic Name: Ranitidine Brand Name: Zantac

ACTION yInhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.

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

SIDE EFFECTS yCNS: Confusion, dizziness, drowsiness, hallucinations, headache yCV: Arrhythmias

NSG. CONSIDERATIONS yAssess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. yNurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid.

yInform patient that it may cause drowsiness or dizziness. yGI: yInform patient that increased fluid and fiber intake may minimize Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, constipation. nausea yAdvise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to yGU: health car professional promptly. Decreased sperm count, impotence yENDO: Gynecomastia yHEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia yLOCAL: Pain at IM site yMISC: Hypersensitivity reactions, vasculitis yInform patient that medication may temporarily cause stools and tongue to appear gray black.

DRUG Generic Name: omeprazole Brand Name: Prilosec

ACTION Gastric-acid pump inhibitor; suppresses gastric acid secretion by specific inhibition of the hydrogen potassium ATP enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production.

CLASSIFICATION Therapeutic: yanti-ulcer yantacid Pharmacologic: yproton-pump inhibitors

SIDE EFFECTS

yCNS; headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream yPhysical: skin lesions; reflexes; urinary output; abdominal abnormalities examination; respiratory auscultation yDermatologic: rash, inflammation, urticaria, yReport severe headache, worsening of symptoms, fever, pruritus, alopecia, dry skin chills. yGI: diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy yRespiratory: URI symptoms, cough, epistaxis

NSG. CONSIDERATIONS yHistory of hypersensitivity to omeprazole or any of its components; pregnancy, lactation

DRUG Generic Name: Clonidine Brand Name: Catapres

ACTION Centrally actingantiadrenergic derivative. Stimulates alpha2adrenergic receptors in CNS to inhibit sympathetic vasomotor centers. Central actions reduce plasma concentrations of norepinephrine. It decreases systolic and diastolic BP and heart rate. Orthostatic effects tend to be mild and occur infrequently. Also inhibits renin release from kidneys..

CLASSIFICATION Therapeutic: yanti-hypertensives Pharmacologic: yadrenergic alpha-2 receptor agonist

y y y y y y y y y y y y y y y y y y y y

SIDE EFFECTS Dry mouth Drowsiness Dizziness Sedation Constipation Depression Swelling of feet Loss of appetite Decreased sexual ability Itching of the eyes Dizziness Nausea Vomiting Nervousness Itching Red skin Darkening of skin Nightmares Vivid dreams Cold feeling in the fingers or toes

NSG. CONSIDERATIONS y Obtain blood pressure immediately before each dose is administered in addition to regular monitoring (be alert on blood pressure fluctuations). y Give without regard to food. y Tablets may be crushed. y Monitor pattern of daily bowel activity and stool consistency. y If clonidine is to be withdrawn, discontinue concurrent beta-blocker therapy several days before discontinuing clonidine. This prevents clonidine withdrawal hypertensive crisis. y Slowly reduce clonidine dosage over 2-4 days.

GENERIC NAME Cimetidine y y

BRAND NAME Cimetine Tagamet

CLASSIFICATION

ACTION

SIDE EFFECTS y y y y y y y y Confusion Dizziness Hallucination Arrhythmias Constipation Diarrhea Nausea anemia

NURSING CONSIDERATIONS

Therapeutic: - Antiulcer Pharmacologic: - Histamine H2 antagonists

Inhibits gastric secretion Inhibits the action of the histamine at the H2 receptor site

Assess for abdominal pain and occult blood Monitor CBC Caution patient to avoid driving and activities that require alertness Advise to increase fluid intake May cause decrease parathyroid concentrations

y y

y y

GENERIC NAME Famotidine y y

BRAND NAME Pepcid Ulcidine

CLASSIFICATION

ACTION

SIDE EFFECTS y y y y y y y y Confusion Dizziness Hallucination Arrhythmias Constipation Diarrhea Nausea Anemia

NURSING CONSIDERATIONS

Therapeutic: - Antiulcer Pharmacologic: - Histamine H2 antagonists

Inhibits gastric secretion Inhibits the action of the histamine at the H2 receptor site

Assess for abdominal pain and occult blood Monitor CBC Caution patient to avoid driving and activities that require alertness Advise to increase fluid intake Test with sulfosalicylic acid

y y

y y

BRAND NAME Lopressor

CLASSIFICATION

ACTION  Blocks stimulation of beta1 adrenergic receptors  Blood pressure and heart rate

METOPROLOL SIDE EFFECTS      Fatigue, Weakness Erectile dysfunction Dizziness / drowsiness Blurred vision Constipation, diarrhea, dry mouth, nausea vomiting,

NURSING CONSIDERATION  Monitor BP, ECG, and PR frequently during therapy  Do not administer if heart rate (< 40bpm)  Monitor I and O daily weights, assess for signs of CHF  Administer with meals or directly after eating  Caution patient safety, this drug causes dizziness/ drowsiness

Beta blockers Antianginals, antihypertensives

ALBUTEROL BRAND NAME Salbutamol nebule CLASSIFICATION ACTION  Binds to beta2 adrenergic receptors in airway smooth muscle, leading to activation of cAMP, intracellular calcium relaxes smooth muscle airways  Bronchodilation SIDE EFFECTS  Nervousness, restlessness, tremor, headache  Chest pain, palpitations, arrhythmias, hypertension  Nausea, vomiting, NURSING CONSIDERATION  Assess for vital signs before and during administration  DO NOT give when there is paradoxical bronchospasm (wheezing)  Administer with meals  Take on regular basis according to the physicians order  Caution patient to avoid smoking and other respiratory irritants  Instruct patients NOT to overuse, it may cause heart damage and life threatening arrhythmias  May cause an unusual taste  Instruct patient the proper use of metered-dose inhaler, Rotahaler, or nebulizer

Bronchodilators Adrenergics

BRAND NAME Silymarin

CLASSIFICATION

ACTION

MILK THISTLE SIDE EFFECTS  Laxative effect, nausea, bloating, anorexia  Allergic reactions

NURSING CONSIDERATION  Assess for liver function  Monitor consistency and frequency of bowel movements  Emphasize the need for blood tests to monitor liver function tests  Avoid alcohol and follow diet consistent with the liver or gall bladder disease being treated

Antidote

 Antioxidant, and hepatoprotectant actions  Helps prevent toxin penetration and stimulates hepatocyte regeneration

BRAND NAME Norvasc

CLASSIFICATION

ACTION  Inhibits transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of contraction and excitation  Systemic vasodilation resulting to BP

AMLODOPINE SIDE EFFECTS  Headache, dizziness, fatigue  Peripheral edema, angina, bradycardia, hypotension, palpitations  Nausea  Flushing

NURSING CONSIDERATION  Monitor BP and pulse rate before and throughout therapy  Monitor I and O, and signs of CHF  May be administered without regards to meals  Take this medication strictly according to doctors order  Caution patient to change positions gradually to minimize orthostatic hypotension  Caution patient safety, this drug causes dizziness  Instruct oral/ dental hygiene  Avoid alcohol and alcohol containing products  Wear protective clothing / sunscreen to prevent photosensitivity

Calcium channel blockers Antihypertensives