Generic name/ Brand name

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Mechanism of action

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Nursing consideration

Generic name: Piperacillin Na Tazobactan Na Brand name: Tazocin

4.5g dilute in 30cc D5W/IVSD x 30 min. q8

-Piperacillin, a broad spectrum, semisynthetic penicillin active against many gram-positive and gram-negative aerobic and anaerobic bacteria, exerts bactericidal activity by inhibition of both septum and cell wall synthesis. Tazobactam, a triazolylmethyl penicillanic acid sulfone, is a potent inhibitor of many -lactamases, including the plasmid and chromosomally mediated enzymes which commonly cause resistance to penicillins and cephalosporins including the thirdgeneration cephalosporins.

-treatment of systemic and local bacterial infections

-Hypersensitivity to penicillins &/or cephalosporins or -lactamase inhibitors.

Diarrhea, nausea, vomiting, rash, leukopenia, thrombocytopenia, neutropenia, hypersensitivity reaction, headache, insomnia, hypotension, phlebitis, thrombophlebitis, constipation, dyspepsia, jaundice, stomatitis, increased blood creatinine, pruritus, urticaria, fever, injection site reaction.

. Conduct periodic electrolyte determination & assessment of organ system functions including renal, hepatic & hematopoietic during prolonged therapy. Discard after 24 hrs. Discontinue use if bleeding manifestations occur.

Generic name/ Brand name Generic name: Enoxaparin Na Brand name: Clexane

Route of admission/ Dosage 0.6cc/SQ q12

Mechanism of action -low-molecularweight heparin that inhibits thrombus and clot formation by blocking factor Xa, factor IIa, preventing the formation of clots.

Indications

Contraindications

Side effect/ Adverse effects

Nursing consideration

-treatment of complicated thromboembolic disorders

-Conditions w/ a high risk of uncontrolled hemorrhage including major bleeding disorders. -Hypersensitivity to enoxaparin Na, heparin or its derivatives including other low MW heparins.

-Hemorrhage. Give deep Thrombocytopenia. subcutaneous Local reactions injections; do not (exceptionally small give enoxaparin by local hematoma). IM injection. Exceptional cases Alternate between of skin necrosis the left and right (discontinue anterolateral and treatment). Rarely, posterolateral cutaneous or abdominal wall. systemic allergic Apply pressure to all reactions. Increase injection sites after in liver enzymes, needle is platelet counts. withdrawn; inspect Hypersensitivity injection sites for cutaneous hematoma; do not vasculitis massage injection sites. Do not mix with other injections or infusions. Provide safety measures to prevent injury to patient who is at risk for bleeding. Have protamine sulfate (enoxaparin

antidote) readily available in case of overdose. Monitor platelet count (discontinue if there is decrease of 30-50% of the initial value).

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Generic name: Fluconazole Brand name: Diflucan

200mg/IVSD q24

-binds to sterols in the fungal cell membrane, changing membrane permeability; fungicidal or fungistatic depending on concentration and organism.

-treatment of systemic candidiasis

-Contraindicated with hypersensitivity to fluconazole. -Use cautiously with renal or hepatic impairment.

-CNS: headache -GI: nausea, vomiting, diarrhea, abdominal pain, AST/ALT elevations -Other: rash

Culture infection before therapy; begin treatment before lab results are returned. Decrease dosages in cases of renal failure. Infuse IV only; not intended for IM or subcutaneous use. Do not add supplement medication to fluconazole. Monitor renal function tests weekly; discontinue or decrease dosage of the drug at any sign of increased renal toxicity. Monitor liver function tests monthly during therapy. The drug will need to be taken for the full course and may need to be taken long term. Instruct patient to report adverse reactions promptly.

Generic name/ Brand name

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Generic name: Cilastatin Na Imipenem Brand name: Tienam

500mg q8 infuse for 2hrs

-imipenem inhibits cell wall synthesis in susceptible bacteria; cilastatin inhibits the renal enzyme that metabolizes imipenem; these drugs are available only in the combined form.

-treatment of intraabdominal infection, septicemia

-hypersensitivity to amide-type local anesthesia. Severe shock/heart block. Not indicated for therapy with IM formulation.

-thrombophlebitis, pain, induration, erythema & tenderness following injection. Rash, urticaria, pruritus, GI disturbances, pseudomembranou s colitis, hematological disturbances, increase in liver enzymes, taste perversion. Myoclonic activity, seizures, psychic disturbances, confusional states. Hearing loss.

TIENAM I.V. is chemically incompatible with lactate and should not be reconstituted in diluents containing lactate. This drug can be administered, however, into an I.V. system through which a lactate solution is being infused. This drug should not be mixed with or physically added to other antibiotics.

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Generic name: Linezolid Brand name: Zyvox

600mg/IVSD x 3 No ST

- bacteriostatic and bacteriocidal: Interferes with protein synthesis on the bacterial ribosome; effective in VRE, Staphylococcus, and methicillinresistant S. aureus (MRSA) and penicillin-resistant pneumococc and S. aureus; is a reversible, nonselective MAOI.

-treatment of Vancomycinresistant enterococcal infection

-hypersensitivity to linezolid

-Diarrhea, headache, nausea. Less common: Oral moniliasis, HTN, dyspepsia, localized abdominal pain, pruritus, tongue discoloration, thrombocytopenia.

Arrange for culture and sensitivity tests before beginning therapy.

Monitor platelet counts regularly if drug is used for 2 weeks or longer. Monitor BP before and periodically if patient is on antidepressants or drugs containing sympathomimetics. Advise patient to avoid foods high in tyramine to avoid risk of severe hypertension. Drug will need to be taken for the full course.

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Generic name: Octreotide acetate Brand name: Sandostatin

0.1mg/SQ q6

- mimics the natural hormone somatostatin; suppresses secretion of serotonin, gastrin, vasoactive intestinal peptide, insulin, glucagon, secretin, motilin, and pancreatic polypeptide; also suppresses growth hormone and decreases splanchnic blood flow.

-emergency management of bleeding of gastroesophageal varices in patients with cirrhosis

-contraindicated with hypersensitivity to octreotide or any of its components -Use cautiously with renal impairment, thyroid disease, diabetes mellitus.

-Crampy abdominal pain, diarrhea, flatulence, constipation, inj site reaction & discomfort at the site of SC inj (pain, rarely, swelling & irritation).

Administer by SQ injection; avoid multiple injections in the same site within short periods. Store ampules in the refrigerator; may be at room temperature on day of use. Monitor blood glucose levels, especially at start of therapy, to detect hypoglycaemia or hyperglycemia. Patients with DM will require close monitoring. Arrange for baseline and periodic gallladder ultrtasound to detect cholelithiasis.

Generic name/ Brand name Generic name: Tranexamic acid Brand name: Hemostan

Route of admission/ Dosage 500mg/IVT q8

Mechanism of action - a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Antifibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogenplasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the

Indications

Contraindications

Side effect/ Adverse effects - GI disorders, nausea, vomiting, anorexia, headache may appear, impaired renal insufficiency, hypotension when IV inj is too rapid.

Nursing consideration

- GI hemorrhage

- 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 anti-inhibitor coagulant concentrates

Administer drug slowly. Report unusual changes in bleeding pattern.

action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis.

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Generic name: Morphine Brand name: Morin

10cc epidural catheter q12

- Principal opium alkaloid; acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

-relief of moderate to severe pain not responding to nonnarcotic analgesics

-post-biliary tract surgery or surgical anastomosis. Comatose. Respiratory depression & obstructive airways disease, acute bronchial asthma, heart failure secondary to chronic pulmonary disease, acute alcoholism, head injuries, raised intracranial pressure & convulsive states i.e. status epilepticus, tetanus or strychnine poisoning.

-lightheadedness, dizziness, sedation, nausea, vomiting, constipation and sweating

Monitor patient for at least 24hrs in a fully equipped and staffed environment because of risk of serious adverse effects. Instruct patient to avoid alcohol, antihistamines, sedatives, tranquilizers, and over-the-counter drugs.

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Generic name: Heparin Brand name:

3000 u /IV bolus

- heparin inactivates factor Xa, therefore inhibiting thrombus and clot formation by blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin, the final steps in the clotting process. Heparin also inhibits the activation of factor XIII and thrombininduced activation of factors V and VIII

-treatment of venous thrombosis

-contraindicated with hypersensitivity to heparin; severe thrombocytopeni a; uncontrolled bleeding;any patient who cannot be monitored regularly with coagulation tests; labor and immediate postpartum period -use cautiously with recent surgery or injury.

-hematologic: loss of hair; -hematologic: haemorrhage; bruising; thrombocytopenia; elevated AST, ALT levels, hyperkalemia; -hypersensitivity: chills, fever, urticarial, asthma -other: osteoporosis, suppression of renalfunction (longterm, high-dose therapy), white clot syndrome

Always check compatibility with other IV solutions. Mix well when adding heparin to IV infusion. Do not add heparin to infusion line of other drugs, and do not piggyback other drugs into heparin line. If it must be done, ensure drug compatibility. Provide safety measures to prevent injury from bleeding. Check for signs of bleeding; monitor blood tests. Have Protamine sulphate (heparin antidote) readily available in case of overdose; each mg neutralizes 100 u of heparin.

Generic name/ Brand name Generic name: Na HCO3 Brand name:

Route of admission/ Dosage 50mg/IV bolus

Mechanism of action - increases plasma bicarbonate; buffers excess hydrogen ion concentration; raises blood pH; reverses the clinical manifestations of acidosis; increases the excretion of free base in the urine, effectively raising the urinary pH; neutralizes or reduces gastric acidity, resulting in an increase in the gastric pH, which inhibits the proteolytic activity of pepsin.

Indications

Contraindications

Side effect/ Adverse effects -Chemical cellulitis because of alkalinity. Tissue necrosis, ulceration or sloughing at the site of infiltration.

Nursing consideration

-treatment of metabolic acidosis

-patients who are losing Cl by vomiting or from continuous GI suction -patients receiving diuretics

Monitor ABG and calculate base deficit. Administer slowly, and do not attempt complete correction within the first 24hr, risk of systemic alkalosis is increased. Check serum potassium levels before IV administration, risk of metabolic acidosis is increased in hypokalemia, requiring reduction of sodium bicarbonate. Monitor IV sites carefully; if infiltration occurs, elevate the site, apply warm soak, and if needed,

arrange for the local insertion of lidocaine or hyaluronidase to prevent sloughing. Monitor cardiac rhythm carefully.