Drug Study

Drug Name Piptazo

PIPERACILLIN/ TAZOBACTAM

Classification
ANTIINFECTIVE; BETA-LACTAM ANTIBIOTIC; ANTIPSEUDOMON AL PENICILLIN

Action Antibacterial combination product consisting of the semisynthetic piperacillin and the betalactamase inhibitor tazobactam. Tazobactam component does not decrease the activity of the piperacillin component against susceptible organisms.

Indication

Adverse Reaction CNS: Headache, insomnia, fever. GI: Diarrhea, constipation, nausea, vomiting, dyspepsia, pseudomembranous colitis. Skin: Rash, pruritus, hypersensitivity reactions.

Interactions Drug: May increase risk of bleeding with ANTICOAGULANT S; probenecid decreases elimination of piperacillin.

Contraindications Hypersensitivity to piperacillin, tazobactam, penicillins, cephalosporins, or beta-lactamase inhibitors such as clavulanic acid and sulbactam. Contraindicated in patients hypersensitive to the drug or other penicillins.

Nursing Considerations Obtain history of hypersensitivity to penicillins, cephalosporins, or other drugs prior to administration. Lab tests: C&S prior to first dose of the drug; start drug pending results. Monitor hematologic status with prolonged therapy (Hct and Hgb, CBC with differential and platelet count). Monitor patient carefully during the first 30 min after initiation of the infusion for signs of hypersensitivity Report rash, itching, or other signs of hypersensitivity immediately. Report loose stools or diarrhea as these may indicate pseudomembranous colitis. Do not breast feed while taking this drug without consulting physician.

Zosyn 2.25/4.5 mg IV q8

Prototype: Piperacillin Sodium

Treatment of moderate to severe infections caused by piperacillinresistant, piperacillin/tazob actam susceptible, beta-lactamase producing strains of microorganisms in the following conditions: appendicitis (complicated by rupture or abscess), uncomplicated and complicated skin and skin structure infections, peritonitis, postpartum endometritis or pelvic inflammatory disease, communityacquired pneumonia (moderate severity only), nosocomial pneumonia (moderate to severe).

Drug Name METRONIDAZ OLE ANST (-)

Classification

Action Antibacterial combination product consisting of the semisynthetic piperacillin and the betalactamase inhibitor tazobactam. Tazobactam component does not decrease the activity of the piperacillin component against susceptible organisms.

Indication Symptomatic Trichomoniasis,

Adverse Reaction Body as a Whole: Hypersensitivity (rash, urticaria, pruritus, flushing), fever, fleeting joint pains, overgrowth of Candida. CNS: Vertigo, headache, ataxia, confusion, irritability, depression, restlessness, weakness, fatigue, drowsiness, insomnia, paresthesias, sensory neuropathy (rare). GI: Nausea, vomiting, anorexia, epigastric distress, abdominal cramps, diarrhea, constipation, dry mouth, metallic or bitter taste, proctitis. Urogenital: Polyuria, dysuria, pyuria, incontinence, cystitis, decreased libido, dyspareunia, dryness of vagina and vulva, sense of pelvic pressure. Special Senses: Nasal congestion. CV: ECG changes (flattening of T wave).

Interactions

Contraindications Blood dyscrasias; active CNS disease; first trimester of pregnancy (category B), lactation.

Nursing Considerations

Flagyl, Flagyl ER, Flagyl IV RTU, Flagyl 375, Metizol, Metric 21, Metro I.V., MetroGel, MetroGel Vaginal, MetroLotion, Noritate, Protostat 500 mg tablets P.O. q8

ANTIINFECTIVE; ANTITRICHOMO NAL; AMEBICIDE; ANTIBIOTIC

treatment of symptomatic trichomoniasis in females and males when the presence of the trichomonad has been confirmed by appropriate laboratory procedures (wet smears and/or cultures). Asymptomatic Trichomoniasis, treatment of asymptomatic females when the organism is associated with endocervicitis, cervicitis or cervical erosi Treatment of Asymptomatic Consorts T. vaginalis infection is a venereal disease.on.
Amebiasis treatment of acute intestinal amebiasis (amebic dysentery) and amebic liver abscess. Anaerobic Bacterial Infections

Drug: ORAL ANTICOAGULAN TS potentiate hypoprothrombin emia; alcohol may elicit disulfiram reaction; oral solutions of citalopram, ritonavir; lopinavir/ritonavi r, and IV formulations of sulfamethoxazole ; trimethoprim, SMX-TMP, nitroglycerin may elicit disulfiram reaction due to the alcohol content of the dosage form; disulfiram causes acute psychosis; phenobarbital increases metronidazole metabolism; may increase lithium levels; fluorouracil, azathioprine may cause transient neutropenia.

Discontinue therapy immediately if symptoms of CNS toxicity develop. Monitor especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities). Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a second course is necessary. Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of CHF. Monitor patients on lithium for elevated lithium levels. Report appearance of candidiasis or its becoming more prominent with therapy to physician promptly.

Blood dyscrasias; active CNS disease; first trimester of pregnancy (category B), lactation.

treatment of serious infections caused by susceptible anaerobic bacteria.

Repeat feces examinations, usually up to 3 mo, to ensure that amebae have been eliminated.

Drug Name Omeprazole 40mg/cap 1cap OD

Classification Substituted benzimidazole Proton pump inhibitor Anti-emetic

Action Chemical effect: Inhibits acid (proton) pump and binds to hydrogenpotassium adenosine triphosphate on secretory surface of gastric acid. Therapeutic effect: Relieves symptoms caused by excessive gastric acid.

Indication  Erosive esophagitis; symptomatic, poorly responsive gastroesophageal reflux disease (GERD)  GERD without erosive esophagitis  Pathologic hypersecretory conditions (such as Zollinger-Ellison syndrome)  Duodenal ulcer  Gastric ulcer  Helicobacter pylori eradication to reduce risk of duodenal ulcer recurrence as part of triple therapy with clarithromycin and amoxicillin  H. pylori eradication to reduce risk of duodenal ulcer recurrence as part of dual therapy with clarithromycin  Heartburn on 2 or more days per week  Posterior laryngitis

Adverse Reaction CNS: -dizziness -headache GI: -abdominal pain -constipation -diarrhea -flatulence -nausea -vomiting Musculoskeletal: -back pain Respiratory: -cough Skin: -rash

Interactions Drug-drug Ampicillin esters, iron derivatives, ketoconazole: -May decrease absorption, Give separately. Clarithromycin: -May increase level of either drug. Monitor patient for drug toxicity. Diazepam, phenytoin, warfarin: -May decrease hepatic clearance of these drugs, possibly leading to increased levels. Monitor absorption and reduce omeprazole bioavailability. Separate administration times by 30 minutes or more. Drug-herb Male fern: -May inactivate herb. Discourage use together. Pennyroyal: -May change the rate at which toxic metabolites of herb form. Discourage using together.

Contraindications  Patient with hypersensitivity to the drug or any of its components.

Nursing Considerations y Assess patients condition before starting therapy and regularly thereafter to monitor drugs effectiveness. y Be alert of adverse reactions and drug interactions. y If adverse GI reaction occurs, monitor patients hydration. y Give capsule 30 minutes before meals; powder for oral suspension 1 hour before meals. y Oral suspension may be used for short-tem treatment of duodenal ulcers, GERD, and maintenance of healing of erosive esophagitis. y Use 2 tbsp of water to mix 1 packet of powder for oral suspension; dont use any other liquid. y Explain importance of taking drug exactly as prescribed. y Warm the patient not to crush or chew tablets or capsules y Inform patient that OTC drug may require 1-4 days for full effect.

Drug Name Lactulose

Classificatio n

Action Chemical effect: Produces osmotic effect in colon. Resulting distention promotes peristalsis. Decrease blood ammonia buildup that causes hepatic encephalopathy, probably as result of bacterial degradation, which lowers pH of colon contents. Therapeutic effect: Relieves constipation, decreases blood ammonia concentration.

Indication  Constipation  To prevent and treat hepatic encephalopathy, including hepatic precoma and coma in patients with severe hepatic disease.  To induce bowel evacuation in geriatric patients with colonic retention of barium and severe constipation after a barium meal examination.

Adverse Reaction GI: -abdominal cramps and distention -belching -diarrhea -flatulence -nausea -vomiting

Interactions Drug-drug Antacids, antibiotics, oral neomycin: -May decrease effectiveness of lactulose. Avoid use together.

Contraindications  Contraindicated in patients on low-galactose diet.  Use cautiously in patients with diabetes mellitus because drug contains lactose, galactose, and other sugars.  In elderly patients, use cautiously because they may be more susceptible to hyponatremia.

Nursing Considerations y Assess patients condition before starting therapy and regularly thereafter to monitor drugs effectiveness. If patient has hepatic encephalopathy, assess mental condition. y Monitor patients electrolyte levels during long-term use. y In a patient with hepatic disease, monitor ammonia level. y Be alert of adverse reactions and drug interactions. Tell the patient to report any occurrence immediately to the prescriber especially when 2-3 stools passed daily. y Diarrhea may indicate overdose. Replace fluid loss. y To minimize sweet taste, dilute with water or fruit juice or give with food. y Store drug at room temperature, preferably below 86F (30C); dont freeze.

Cephulac, Chronulac
30cc OD at HS

GASTROINT ESTINAL AGENT; HYPEROSM OTIC LAXATIVE

Drug Name

Classification

Action

Indication

Adverse Reaction

Interactions

Contraindications

Nursing Considerations

VITAMIN K Generic name: Phytonadione (Vitamin K) Brand name: Mephyton

fat-soluble vitamins; anti-fibrinolytic agents

Antihemorrhagic factor that promotes hepatic formation of active prothrombin

Phytonadione is used in the prevention and treatment of hypoprothrombin emia caused by vitamin K defi ciency, oral anticoagulants, or other factors which impair the absorption or synthesis of vitamin K. Phytonadione is also used in the prevention and treatment of hemorrhagic disease of the newborn. Phytonadione may have a role in restoring normal clotting time in patients with hypoprothrombin emia induced by salicylates, sulfonamides, quinidine, quinine or broad-spectrum antibiotics, when interference with vitamin K activity is clearly the cause.

Deaths have occurred following i.v. administration of phytonadione. Transient flushing sensations and peculiar sensations of taste have been observed following phytonadione injection as well as rare instances of dizziness, rapid and weak pulse, profuse sweating, brief hypotension, dyspnea, and cyanosis. Bronchospasm, shock, cardiac and/or respiratory arrest may also occur. Pain, swelling, and tenderness at the injection site may occur. The possibility of allergic sensitivity (i.e., rash, urticaria), including an anaphylactoid reaction, should be kept in mind. Large doses of vitamin K or its analogues may further depress liver function in patients with

Phylloquinone (K1) or menaquinone (K2) are capable of blocking the blood thinning action of anticoagulants like warfarin, which work by interfering with the action of vitamin K. They also reverse the tendency of these drugs to cause arterial calcification in the long term.

Hypersensitivity to any component of this medication.

Instruct patient to take this drug as ordered Cooking does not destroy substantial amounts of vitamin K Caution patient to avoid IM injection and activities leading to injury. Advise patient to report any symptoms of unusual bleeding or bruising. Patients receiving vitamin K therapy should not take OTC Medications without advice of Health Care professionals. Advise patient to carry identification at all times describing disease process. Emphasize the importance of frequent lab tests to monitor coagulation factor

severe hepatic disease and thereby further decrease the concentration of prothrombin.

Drug Name
HNBB Buscopan [tab] 10mg IV q8

Classification
Antispasmodics

Action Relieve cramps or spasms of the stomach, intestines and bladder.

Indication Paroxysmal pain in diseases of the stomach or intestine, spastic pain & functional disorders in the biliary & urinary tracts & female uterine organs e.g, dysmenorrhea).

Adverse Reaction
Rubefaction, allergic reactions w/ exanthema, thrombocytopenia, leucopenia; agranulocytosis(in isolated case associated w/ paracetamol), pancytopenia. Bronchospasm (in predisposed patient).

Interactions Tell your doctor of all nonprescription or prescription medication you use, especially of: antidepressants (tricyclic type), MAO Inhibitors (e.g., phenelzine, linezolid, tranylcypromine, isocarboxazid, selegiline, furazolidone), quinidine, amantadine, antihistamines (e.g., diphenhydramine), anticholinergics, potassium chloride supplements, antacids, absorbent-type antidiarrhea medicines (e.g., kaolin-pectin). Do not start or stop any medicine without doctor or pharmacist approval.

Contraindications

Nursing Considerations
Hepatic & renal dysfunction, Gilbert's syndrome. Pregnancy esp during 1st trimester

Myastheniagravis, megacolon. Should not be given to patients who have prior sensitivity to HNBB or paracetamol or any component of buscopan plus.

Drug Name
Brand Name: Hemostan Fibrinon, Cyklokapron, Lysteda, Transamin Generic Name: Tranexamic Acid Classification: Hemostatic Drug Dosage/Frequen cy: 25mg- 50mg BID/TID Route: POInhibits

Classification
Antispasmodics Anti-fibrinolytic, antihemorrhagic

Action Inhibits break down of fibrin clots. It acts primarily by blocking the binding of plasmin to fibrin; direct inhibition of plasmin occurs only to a limited degree.

Indication Treatment and prophylaxis of hemorrhage associated with excessive ibrinolysis. Prophylaxis of hereditary angioedema.

Adverse Reaction Patient with active intravascular clotting because of the rick of thrombosis. Severe renal insufficiency. Patients with microscopic hematuria.

Interactions Tell your doctor of all nonprescription or prescription medication you may use, especially of: aspirin/NSAIDs (e.g., ibuprofen), anticoagulants ("blood thinners" such as warfarin or heparin), aminocaproic acid, factor IX complex, anti-inhibitor coagulant concentrates, drugs that can cause blood clots (e.g., estrogens or birth control pills). Many nonprescription products contain aspirin/NSAIDs. Check labels carefully and consult your pharmacist. Do not start or stop any medicine without doctor or pharmacist approval.

Contraindications

Nursing Considerations

Gastrointestinal disturbances. Hypotension, particularly after rapid IV administration. Thrombotic omplications have been reported. Instances of transient disturbance of colour visiona ssociated with its use.
Allergic reaction to the drug or hypersensitivity Presence of blood clots (eg, in the leg, lung, eye, brain), have a history of blood clots, or are at risk for blood clots Current administration of factor IX complex concentrates or antiinhibitor coagulant concentrates

Assess patients history, if with active intravascular clotting, predisposed to thrombosis; hemorrhage due to disseminated intravascular coagulation. Monitor anticoagulant cover. Perform eye examination. Perform liver function tests. Perform blood tests. Obtain prothrombintime of the patient.
Unusual change in bleeding pattern should be immediately reported to the physician. For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years

old; safety and effectiveness in these children have not been confirmed. The medication can be taken with or without meals. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once.