Brand Name: Omnipen, Polycillin, Principen Generic Name: Ampicillin Indication: Infections of the Genitourinary Tract including Gonorrhea:

E. coli, P. mirabilis, enterococci, Shigella, S. typhosa and other Salmonella, and nonpenicillinaseproducing N. gononhoeae. Infections of the Respiratory Tract: Nonpenicillinase-producing H. influenzae and staphylococci, and streptococci including streptococcus pneumoniae. Infections of the Gastrointestinal Tract: Shigella, S. typhosa and otherSalmonella, E. coli, P. mirabilis, and enterococci. Meningitis: O. Meningitides. Dosage: Adult- PO/IM/IV- The recommended dose range is 0.5 to 3gm every 6 hours or 4 times/day. Child- 25 to 50mg/kg/day. Contraindications: Contraindicated in patients hypersensitive to drug or other penicillins. Side Effects: Common side effects of ampicillin include nausea, vomiting,loss of appetite, diarrhea, abdominal pain, rash, itching, headache,confusion and dizziness. Adverse Reactions: CNS: seizures CV: thrombophlebitis, vein irritation GI: nausea, vomiting, diarrhea, glossitis, stomatitis Hematologic: agranulocytosis, anemia, eosinophilia, leukopenia, thrombocytopenia, thrombocytopenic purpura Other: hypersensitivity reactions (anaphylaxis, maculopapular rash, Urticaria), overgrowth of nonsusceptible organisms, pain at Injection site. Mode of Action: Kills susceptible bacteria, including non-penicillase-producing gramPositive bacteria and many gram-negative organisms. Nursing Responsibilities: Culture infected area before treatment; reculture area if response is not as expected. Check IV site carefully for signs of thrombosis or drug reaction. Do not give IM injections at the same site; athrophy can occur. Monitor injection site. Administer orally on an empty stomach 1hr before or 2 hrs after meals with full glass of water; do not give with fruit juice or soft drinks.

Brand Name: Clarofan

Generic Name: Cefotaxime Classification: Antibiotic Indication: Lower respiratory tract infections, including pneumonia Genitourinary infections. Urinary tract infections Gynecologic infections, including pelvic inflammatory disease,endometritis and pelvic Cellulitis. Bacteremia/Septicemia Skin and skin structure infections Intra-abdominal infections including peritonitis Bone and/or joint infections Central nervous system infections, e.g., meningitis and ventriculitis Dosage: Cesarean Section Patients The first dose of 1 gram is administered intravenously as soon as the umbilical cord is clamped. The second and third doses should be given as 1 gram intravenously or intramuscularly at 6 and 12 hours after the first dose. Neonates, Infants, and Children The following dosage schedule is recommended: Neonates (birth to 1 month): 0-1 week of age 1-4 weeks of age 50 mg/kg per dose every 12 hours IV 50 mg/kg per dose every 8 hours IV

Contraindications: Contraindicated in patients who have shown hypersensitivity to cefotaxime sodium, or the cephalosporin group of antibiotics. Side effects: pain, irritation, or a hard lump where the injection was given; stomach pain, nausea, vomiting; headache; or vaginal itching or discharge. Adverse Reactions: dizziness, fever, headache, malaise, paresthesia, abdominal cramps, anorexia, diarrhea, dyspepsia, glossitis, nausea, oral candidiasis, dyspnea, tenesmus, vomiting, maculopapular, erythematous rashes, uticaria,hypersensitive reactions. Mode of Action: Hinders or kills susceptible bacteria.

Nursing responsibilities: Determine previous hypersensitivity reactions to cephalosporins and penicillins, and history of other allergies, particularly to drugs, before therapy is initiated. Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated. Therapy may be instituted pending test results. Serum creatinine, creatinine clearance, BUN should be evaluated at regular intervals during therapy and for several months after drug has been discontinued. Perform periodic hematologic studies (including PT and PTT) and evaluation of hepatic functions with high doses or prolonged therapy. Monitor I&O rates and patterns: Report change in I&O in patients with impaired renal function or with chronic UTI or who are receiving high dosages or an aminoglycoside concomitantly. Superinfection due to overgrowth of nonsusceptible organisms may occur, particularly with prolonged therapy. Report onset of diarrhea promptly. Check for fever. If diarrhea is mild, discontinuation of cefotaxime may be sufficient. If diarrhea is severe, suspect antibiotic-associated pseudomembranous colitis, a life-threatening superinfection (may occur in 49 d or as long as 6 wk after cephalosporin therapy is discontinued). Chronically ill or debilitated older adult patients undergoing abdominal surgery or those in an intensive care unit are most vulnerable.

Brand Name: Amikin Generic Name: Amikacin Classification: Antibiotic Indication: Indicated in the short-term treatment of serious infections due to susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, species of indole-positive and indole-negative Proteus, Providencia species, KlebsiellaEnterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species. Dosage: The recommended dosage for adults, children and older infants with normal renal function is 15 mg/kg/day divided into 2 or 3 equal doses administered at equallydivided intervals ie., 7.5 mg/kg q12h or 5 mg/kg q8h. Treatment of patients in the heavier weight classes should not exceed 1.5g/day. Contraindications: A history of hypersensitivity to amikacin is a contraindication for its use. A history of hypersensitivity or serious toxic reactions to aminoglycosides maycontraindicate the use of any other aminoglycoside because of the known crosssensitivities of patients to drugs in this class.

Side effects: Nausea, vomiting, stomach upset, or loss of appetite may occur. Pain/irritation/redness at the injection site may infrequently occur. Adverse Reactions: headache, lethargy, neuromuscular blockade, ototoxicity, nephrotoxicity, hepatic necrosis, anaphylaxis, hypersensitivity reactions Mode of Action: Kills susceptible bacteria and many aerobic gram-negative organisms and some aerobic gram-positive organisms. Ineffective against anaerobes. Nursing Responsibilities:

Baseline tests: Before initial dose, C&S; renal function and vestibulocochlear nerve function (and at regular intervals during therapy; closely monitor in the older adult, patients with documented ear problems, renal impairment, or during high dose or prolonged therapy).

Monitor peak and trough amikacin blood levels: Draw blood 1 h after IM or immediately after completion of IV infusion; draw trough levels immediately before the next IM or IV dose.

Lab tests: Periodic serum creatinine and BUN, complete urinalysis. With treatment over 10 d, daily tests of renal function, weekly audiograms, and vestibular tests are strongly advised.

Monitor serum creatinine or creatinine clearance (generally preferred) more often, in the presence of impaired renal function, in neonates, and in the older adult; note that prolonged high trough (>8 mg/mL) or peak (>3035 mg/mL) levels are associated with toxicity.

Monitor S&S of ototoxicity (primarily involves the cochlear (auditory) branch; highfrequency deafness usually appears first and can be detected only by audiometer); indicators of declining renal function; respiratory tract infections and other symptoms indicative of superinfections and notify physician should they occur.

Monitor for and report auditory symptoms (tinnitus, roaring noises, sensation of fullness in ears, hearing loss) and vestibular disturbances (dizziness or vertigo, nystagmus, ataxia).

Monitor & report any changes in I&O, oliguria, hematuria, or cloudy urine. Keeping patient well hydrated reduces risk of nephrotoxicity; consult physician regarding optimum fluid intake.

Brand Name: Ponstel Generic Name: Mefenamic Acid Classification: nonsteroidal anti-inflammatories (NSAIDs) Indication: This medication is a non-steroidal anti-inflammatory drug (NSAID), prescribed for dysmenorrhea and other pain. It decreases inflammation and uterine contractions. Dosage: PO- The recommended dose is 500 mg as an initial dose followed by 250 mg every 6 hours as needed. Contraindications: Contraindicated in patients who have experienced asthma, hives, allergic reactions after taking aspirin or other NSAIDs, peri-operative pain, ulcer, kidney disease and hypersensitivity. Side Effects: diarrhea, constipation, gas or bloating, headache, dizziness, nervousness, ringing in the ears Adverse Reactions: blurred vision, unexplained weight gain, fevers, blisters, rash, itching, hives, swelling of the eyes, lips, tongue, throat, hands, arms, feet, ankles, lower legs, difficulty breathing or swallowing, pale skin, fast heartbeat, excessive tiredness, unusual bleeding or bruising, lack of energy, nausea, loss of appetite, back pain, difficult or painful urination. Mode of Action: Mefenamic acid binds the prostaglandin synthetase receptors COX-1 and COX-2, inhibiting the action of prostaglandin synthetase. As these receptors have a role as a major mediator of inflammation and/or a role for prostanoid signaling in activity-dependent plasticity, the symptoms of pain are temporarily reduced. Nursing Responsibilities:

Assess patients who develop severe diarrhea and vomiting for dehydration and electrolyte imbalance. Lab tests: With long-term therapy (not recommended) obtain periodic complete blood counts, Hct and Hgb, and kidney function tests. Discontinue drug promptly if diarrhea, dark stools, hematemesis, ecchymoses, epistaxis, or rash occur and do not use again. Contact physician. Notify physician if persistent GI discomfort, sore throat, fever, or malaise occur. Do not drive or engage in potentially hazardous activities until response to drug is known. It may cause dizziness and drowsiness. Monitor blood glucose for loss of glycemic control if diabetic. Do not breast feed while taking this drug without consulting physician.

Brand Name: Reglan, Reglan ODT, Metozol ODT, Octamide, Generic Name: Metoclopramide Classification: anti-emetic Indication: To prevent or reduce nausea and vomiting induced by cisplatin alone or with other chemotherapeutics. To prevent or reduce postoperative nausea and vomiting. To facilitate small-bowel or upper G.I intubation and aid in radiologic examinations. Delayed Gastric emptying caused by diabetic gastroparesis. Gastroesophaegal reflux disease. Dosage: The usual dose of metoclopramide for treating GERD is 10-15 mg four times daily, 30 minutes before each meal. Gastroparesis is treated with 10 mg administered orally four times daily, 30 minutes before each meal and at bedtime. Contraindications: Contraindicated in patients hypersensitive to the drug or any of its components; patients allergic to procainamide may also be allergic to metoclopramide. Also contraindicated in patients taking drugs that are likely to cause extrapyramidal reactions, in those for whom stimulation of GI motility might be dangerous and in those with pheochromocytoma or seizure disorder. Side Effects: Abdominal or stomach pain or tenderness, chills, clay colored stools, convulsions (seizures), dark urine, difficulty with breathing, difficulty with speaking or swallowing, dizziness or fainting, fast or irregular heartbeat, fever, general feeling of tiredness or weakness, headache (severe or continuing), inability to move the eyes, increase in blood pressure, increased sweating, itching, lip smacking or puckering, loss of appetite, loss of balance control, loss of bladder control, mask-like face, muscle spasms of the face, neck, and back, nausea and vomiting, puffing of the cheeks, rapid or worm-like movements of the tongue, shuffling walk, skin rash, sore throat, stiffness of the arms or legs, swelling of the feet or lower legs, tic-like or twitching movements, trembling and shaking of the hands and fingers, twisting movements of the body, uncontrolled chewing movements, uncontrolled movements of the arms and legs, unusually pale skin, weakness of the arms and legs, yellow eyes or skin

Adverse Reactions: anxiety, dizziness, drowsiness, dystonic reactions, fatigue, fever, headache, insomnia, lassitude, restlessness, sedation, seizures, suicidal ideation, arrhythmias,AV block, bradycardia, heart failure, hypotension, bowel disturbances, diarrhea, nausea, rashes, loss of libido. Mode of Action: Metoclopramide inhibits gastric smooth muscle relaxation produced by dopamine, therefore increasing cholinergic response of the gastrointestinal smooth muscle. It accelerates intestinal transit and gastric emptying by preventing relaxation of gastric body and increasing the phasic activity of antrum. Nursing Responsibilities:

Monitor BP carefully during IV administration. Monitor for extrapyramidal reactions, and consult physician if they occur. Monitor diabetic patients, arrange for alteration in insulin dose or timing if diabetic control is compromised by alterations in timing of food absorption. Provide diphenhydramine injection on standby in case extrapyramidal reactions occur (50 mg IM). Provide phentolamine on standby in case of hypertensive crisis (most likely to occur with undiagnosed pheochromocytoma).

Brand Name: Toradol Generic Name: Ketorolac Classification: Analgesic, Anti-inflammatory Indication: Short-term management of pain, ocular itching caused by seasonal allergic rhinitis, postoperative inflammation following cataract surgery, pain and burning or stinging following corneal refractive surgery. Dosage: The recommended adult intravenous single dose is 15 to 60 mg. Multiple intravenous doses of 15 or 30 mg every 6 hours, not to exceed 60 or 120 mg a day, also may be used. Following intravenous therapy, the recommended dose is one or two tablets initially followed by 1 tablet every 4-6 hours, not to exceed 40 mg daily. The smaller dose is used for patients with poor kidney function or those older than 65 years. Contraindications: Contraindicated in patients hypersensitive to the drug or any of its components; in those with a history of nasal polyps, angioedema, bronchospastic

reactivity or allergic reactions to aspirin or other NSAIDs; in those with advance renal impairment and in those at risk for renal impairment as a result of volume depletion. Also contraindicated in patients with a high risk of bleeding. Contraindicated for perioperative pain in patients requiring coronary artery bypass graft surgery. Side effects: rash, ringing in the ears, headaches, dizziness, drowsiness, abdominal pain, nausea,diarrhea, constipation, heartburn, and fluid retention. Adverse Reactions: dizziness, drowsiness, headache, insomnia, syncope, edema, hypertension, palpitations, corneal edema, keratitis, diarrhea, anemia, purpura, sweating, pain at injection site. Mode of Action: Ketorolac reduces the production of prostaglandins, chemicals that cells of the immune system make that cause the redness,fever, and pain of inflammation and that also are believed to be important in the production of noninflammatory pain. It does this by blocking the enzymes that cells use to make prostaglandins (cyclooxygenase 1 and 2). Nursing Responsibilities: Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy. Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes (chills,fever,muscles aches, pain) occur. Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.

Brand Name: Ultram, Ultram ER Generic Name: Tramadol Classification: Analgesic Indication: Moderate to moderately severe pain. Dosage: The recommended dose of tramadol is 50-100 mg (immediate release tablets) every 4-6 hours as needed for pain. The maximum dose is 400 mg/day. To improve tolerance patients should be started at 25 mg/day, and doses may be increased by 2550 mg every 3 days to reach 50-100 mg/day every 4 to 6 hours.. Tramadol may be taken with or without food. Contraindications: Contraindicated in patients hypersensitive to the drug or any of its components, and in those with acute intoxication from alcohol, hypnotics, centrallyacting analgesic, opioids or psychotropic drugs. Side Effects: Abdominal problems, such as diarrhea, constipation, nausea, or stomach pain,d epression, including feelings of sadness and discouragement, skin problems, such as itchiness, rash, or sweating,general aches and pains in the muscles and joints Adverse Reactions: anxiety, asthenia, confusion, dizziness, euphoria, headache, malaise, nervousness, vertigo, vasodilation, visual disturbances, abdominal pain, anorexia, constipation, diarrhea, urinary frequency, flatulence, dry mouth, hypertonia, rash, sweating Mode of Action: Tramadol binds to receptors in the brain (narcotic or opioid receptors) that are important for transmitting the sensation of pain from throughout the body to the brain.

Nursing Responsibilities: Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration. Assess BP & RR before and periodically during administration. Respiratory depression has not occurred with recommended doses. Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms. Prolonged use may lead to physical and psychological dependence and tolerance, although these may be milder than with opioids. This should not prevent patient from receiving adequate analgesia. Most patients who receive tramadol for pain d not develop psychological dependence. If tolerance develops, changing to an opioid agonist may be required to relieve pain. Tramadol is considered to provide more analgesia than codeine 60 mg but less than combined aspirin 650mg/codeine 60 mg for acute postoperative pain. Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or Mao inhibitors), opioid analgesics, or other durgs that decrese the seizure threshold. Overdose may cause respiratory depression and seizures. Naloxone (Narcan) may reverse some, but not all, of the symptoms of overdose. Treatment should be symptomatic and supportive. Maintain adequate respiratory exchange. Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.

Brand Name: Ceftin, Zinacef Generic Name: Cefuroxime Classification: Antibiotic Indication: Serious lower respiratory tract infection, UTI, skin or skin-structure infections, bone or joint infection, septicaemia, meningitis and gonorrhea. Perioperative prevention. Bacterial exacerbations of chronic bronchitis or secondary bacterial infection of acute bronchitis. Acute bacterial maxillary sinusitis. Pharyngitis and tonsillitis. Otitis media. Uncomplicated skin and skin-structure infection. Uncomplicated UTI. Impetigo. Dosage: Typical adult oral doses are 250 or 500 mg twice daily for 7-20 days depending on the type and severity of the infection.

Contraindications: CEFTIN (cefuroxime axetil) products are contraindicated in patients with known allergy to the cephalosporin group of antibiotics. Side Effects: Chills, diarrhea, fever, general feeling of illness or discomfort, headache, itching of the vagina or genital area, pain during sexual intercourse, rigidity, sweating, thick, white vaginal discharge with no odor or with a mild odor Adverse Effects: Diarrhea, decreased hemoglobin or hematocrit ,Eosinophilia, nausea or vomiting (37%), vaginitis (<5%),transient rise in hepatic transaminases (2-4%),diaper rash (3%),increase in alkaline phosphatase (2%), Thrombophlebitis (2%),Increase in lactate dehydrogenase, Anemia, Cholestasis,Colitis,Dyspnea,Epidermal necrolysis,Increase in blood urea nitrogen (BUN) and creatinine, Jaundice, Nephritis, Prolonged prothrombin time (PT)/international normalized ratio (INR),Rash, Stevens-Johnson syndrome, Stomach cramps, Transient neutropenia and leukopenia, Urticaria Mode of Action: Cefuroxime is a semisynthetic cephalosporin antibiotic, chemically similar to penicillin. Cephalosporins stop or slow the growth of bacterial cells by preventing bacteria from forming the cell wall that surrounds each cell. The cell wall protects bacteria from the external environment and keeps the contents of the cell together. Without a cell wall, bacteria are not able to survive. Nursing Responsibilities:

Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated. Therapy may be instituted pending test results. Monitor periodically BUN and creatinine clearance. Inspect IM and IV injection sites frequently for signs of phlebitis. Report onset of loose stools or diarrhea. Although pseudomembranous colitis rarely occurs, this potentially life-threatening complication should be ruled out as the cause of diarrhea during and after antibiotic therapy. Monitor for manifestations of hypersensitivity. Discontinue drug and report their appearance promptly. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes. Report loose stools or diarrhea promptly. Report any signs or symptoms of hypersensitivity Do not breast feed while taking this drug.

Brand Name: Zantac Generic Name: Ranitidine Classification: Antiulcerative Indication: intractable duodenal ulcer; pathologic hypersecretory conditions, duodenal and gastric ulcer, maintenance therapy for dueodenal ulcer, gastroesophageal reflux disease, erosive esophagitis, self-medication for heartburn, acid indigestion and sour stomach Dosage: Ranitidine may be taken with or without food.

Usual oral doses for treating ulcers and GERD are 150 mg twice daily or 300 mg at bedtime. The maintenance dose is 150 mg daily. Erosive esophagitis is treated with 150 mg 4 times daily. Zollinger Ellison syndrome may be treated with as much as 6 g daily. Heartburn is treated with 75 mg or 150 mg once or twice daily 30-60 minutes before consuming meals or beverages that cause heartburn.

Self-medication should not last longer than 2 weeks unless advised by a physician. Contraindications: Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Side Effects: constipation, diarrhea, fatigue,headache, insomnia, muscle pain, nausea, and vomiting. Major side effects are rare; they include: agitation, anemia, confusion, depression, easy bruising or bleeding, hallucinations, hair loss, irregular heartbeat, rash, visual changes, and yellowing of the skin or eyes. Adverse Reaction: malaise, vertigo, blurred vision, abdominal discomfort, constipation, diarrhea, nausea, vomiting, jaundice, rash, burning and itching at injection site Mode of Action: Relieves GI discomfort.

Nursing Responsibilities: Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray black